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目的:探讨机器人手术系统行胰腺癌根治术的有效性、安全性及临床疗效。方法:回顾性分析我院外科自2010年4月至2013年8月收治并实施达芬奇机器人胰腺癌根治术的26例胰腺导管腺癌病人的临床资料。结果:26例病人中3例因肿瘤侵犯血管及周围脏器或术中分离困难,中转开腹手术。10例胰头癌根治术平均手术时间为(469.3±148.2)min,平均术中出血量为(594.0±304.5)mL;15例胰体尾癌根治术平均手术时间为(182.0±66.3)min,平均术中出血量为(343.3±376.8)mL;1例胰腺中段切除术手术时间为240 min,术中出血150 mL。全组26例清扫淋巴结(4.0±2.1)枚,术后胃肠功能恢复时间为(3.3±1.3)d,术后住院(24.1±12.0)d。10例出现术后并发症,其中胰漏5例,胆漏2例,吻合口出血1例,胰漏合并门静脉血栓形成1例,吻合口出血合并急性肾功能衰竭1例。除1例因术后出血、急性肾衰死亡,1例行栓塞治疗外,其余病人均经保守治疗后痊愈。25例随访时间为(10.8±5.6)(1~40)个月,术后肿瘤复发转移死亡10例,肿瘤局部复发1例。结论:机器人手术系统行胰腺癌根治术安全、可行,手术创伤小、术后恢复快,扩大了机器人手术在胰腺肿瘤治疗上的适用范围。
Objective: To investigate the effectiveness, safety and clinical efficacy of robotic surgical system in the treatment of pancreatic cancer. Methods: The clinical data of 26 patients with pancreatic ductal adenocarcinoma admitted to our hospital from April 2010 to August 2013 with radical mastectomy of da Vinci robot were retrospectively analyzed. Results: Three of the 26 patients were involved in laparotomy due to tumor invasion of blood vessels and surrounding organs or intraoperative separation difficulties. The average operative time was (469.3 ± 148.2) min in 10 cases of pancreatic cancer of the pancreas and the average blood loss was (594.0 ± 304.5) mL. The average operation time of the radical operation in 15 cases of pancreatic cancer of the pancreas was (182.0 ± 66.3) The mean intraoperative blood loss was (343.3 ± 376.8) mL. One case of middle pancreatectomy was operated for 240 min and the intraoperative bleeding was 150 mL. The total number of dissected lymph nodes (4.0 ± 2.1) in 26 cases was (3.3 ± 1.3) days postoperatively, and was postoperatively hospitalized (24.1 ± 12.0 days). Ten cases had postoperative complications, including 5 cases of pancreatic leakage, 2 cases of bile leakage, 1 case of anastomotic bleeding, 1 case of pancreatic leakage with portal vein thrombosis, 1 case of anastomotic bleeding complicated with acute renal failure. In addition to a case of postoperative bleeding, acute renal failure death, 1 case of embolization, the remaining patients were cured after conservative treatment. Twenty-five patients were followed up for (10.8 ± 5.6) (1 ~ 40) months. Tumor recurrence and metastasis occurred in 10 and tumor recurrence in 1 patient. Conclusion: The robotic surgery system is safe and feasible in the treatment of pancreatic cancer and has less trauma and postoperative recovery. It expands the scope of robotic surgery for pancreatic cancer.