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目的总结daVinci机器人手术系统在肝门部胆管癌切除手术中的早期应用经验。方法复习第二炮兵总医院2009年1~6月57例机器人辅助的肝胆胰手术病例临床资料,介绍其中6例肝门部胆管癌切除术的临床效果。结果6例中,男5例,女1例;年龄(60±8)岁。Bismuth分型I型1例,Ⅲb型2例,Ⅳ型3例(1例术前行PTCD1个月)。BismuthI型病人实施机器人辅助下根治性胆管癌切除、胆肠吻合术;Ⅲb型病人1例实施左半肝切除术,1例实施肝门部胆管癌切除、胆管外引流术;BismuthⅣ型病人均实施机器人辅助下胆管癌切除、间置胆囊胆道重建术。术后1例进食后发生不全性肠梗阻,禁食1d后缓解;未发生胆漏、腹膜炎等其他并发症。中位随访时间3个月,未见明确肿瘤复发征象。结论daVinci机器人手术系统实施肝门部胆管癌切除术完全可行,具有手术视觉更扩大清晰,深度操作更确切容易,解剖性探查精细灵巧,手术方案可进可退,创伤小恢复快等优点。机器人辅助下肝门部胆管癌手术对病人的远期生存的影响,仍须进一步观察。
Objective To summarize the early experience of daVinci robotic surgery system in the resection of hilar cholangiocarcinoma. Methods The clinical data of 57 robot assisted hepatobiliary and pancreatic surgery cases from January to June 2009 in the Second Artillery General Hospital were reviewed, and the clinical results of 6 cases of hilar cholangiocarcinoma resection were introduced. Results 6 cases, 5 males and 1 female; age (60 ± 8) years. Bismuth type Ⅰ in 1 case, Ⅲ b in 2 cases, type Ⅳ in 3 cases (1 case of preoperative PTCD 1 month). Bismuth type I patients underwent robot-assisted radical cholangiocarcinoma resection and cholangioenterostomy. One patient with type IIIb was treated with left-hysterectomy, one patient with hilar cholangiocarcinoma and bile duct drainage and Bismuth type IV patients Robot assisted cholangiocarcinoma resection, gallbladder biliary reconstruction. Postoperative one case of incomplete intestinal obstruction after eating, fasting after 1d; no bile leakage, peritonitis and other complications. The median follow-up time of 3 months, no clear signs of tumor recurrence. Conclusions DaVinci robotic surgical system is feasible and feasible for hilar cholangiocarcinoma resection. It has the advantages of more clear visualization of surgical vision, more accurate and accurate operation, anatomical exploration of dexterous dexmedetomidine, retraction of surgical procedures and quick trauma recovery. Robot-assisted hilar cholangiocarcinoma surgery on the long-term survival of patients still need further observation.