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目的:总结机器人手术系统在肝脏切除术应用中的临床经验。方法:对于2009年1月至2010年7月实施的17例机器人外科手术系统所行肝切除术的资料进行回顾性分析。结果:17例机器人肝脏手术病人中男∶女=8:9,平均年龄(55±16)(27～85)岁。包括原发性肝细胞癌3例;胆管细胞癌3例(BismuthⅢb型肝门部胆管癌1例,肝内胆管囊腺癌2例);转移性肝癌3例;良性肝脏肿瘤4例(肝血管瘤3例,胆管囊腺瘤1例);左肝内胆管结石4例。手术方式:规则性左半肝切除术2例,左肝外叶切除术5例,肝局部或楔形切除7例,亚肝段(s5a)切除术1例,联合其他机器人术式12例。机器人肝切除的平均手术时间为280 min,术中出血量为150 mL。术中发生大出血3例,其中2例(11.8%)为巨大肝血管瘤中转开腹切除。采用Pringle法肝切除4例,采用肝实质缝扎和超声刀离断肝实质交替法实施左肝外叶切除4例。机器人肝切除病例的平均住院时间为7(5～16)d。术后发生严重并发症2例(11.8%):腹腔内出血1例,肺部感染1例,经保守治疗治愈,无胆漏等严重并发症和围手术期死亡。结论:机器人肝切除术安全、可行,疗效确切。探索适合机器人手术系统优势的肝切除止血方法等创新性技术将是今后机器人肝切除的重点之一。
Objective: To summarize the clinical experience of robotic surgery in hepatectomy. Methods: The data of hepatectomy performed in 17 robotic surgical systems performed from January 2009 to July 2010 were analyzed retrospectively. Results: Among 17 robotic liver surgery patients, the male and female were 8: 9 and the mean age was (55 ± 16) (27-85) years old. Including 3 cases of primary hepatocellular carcinoma; 3 cases of cholangiocarcinoma (BismuthⅢb hilar cholangiocarcinoma, 2 cases of intrahepatic cholangiocarcinoma); 3 cases of metastatic liver cancer; 4 cases of benign liver tumor (hepatic vessels Tumor in 3 cases, bile duct cystadenoma in 1 case); left intrahepatic duct stones in 4 cases. Surgical methods: 2 cases of regular left hepatectomy, 5 cases of left hepatic resection, 7 cases of local hepatectomy or wedge resection, 1 case of sub-hepatectomy (s5a) and 12 cases of other robotic procedures. The average operation time of robotic liver resection was 280 min and the intraoperative blood loss was 150 mL. Intraoperative bleeding occurred in 3 cases, of which 2 cases (11.8%) for large hepatic hemangioma conversion to open surgery. Four cases of hepatectomy with Pringle method and four cases of extrahepatic lobectomy with hepatic parenchymal suture and ultrasonic knife were performed. The average length of hospital stay for robotic liver resections was 7 (5-16) days. There were 2 cases (11.8%) with severe complications after operation: 1 case of intraperitoneal hemorrhage and 1 case of pulmonary infection. The patients were cured by conservative treatment without serious complications such as bile leakage and perioperative death. Conclusion: Robotic hepatectomy is safe, feasible and effective. Innovative technologies such as the hepatectomy and hemostasis methods that are suitable for the advantages of robotic surgical systems will be one of the focuses of robotic liver resection in the future.