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目的探讨机器人辅助胰头十二指肠切除术治疗胰头部恶性肿瘤的临床应用价值。方法回顾性分析2010年5月至2014年4月上海瑞金医院应用达芬奇机器人辅助胰头十二指肠切除术治疗的38例胰头部恶性肿瘤患者临床资料。其中男25例,女13例;平均年龄(59±10)岁。所有患者均签署知情同意书,符合医学伦理学规定。采用“五孔法”置入3枚机器人专用套管(Trocar)及1枚镜头Trocar和1枚辅助Trocar,放入机器人臂,机器人辅助下行胰头十二指肠切除术。观察患者围手术期情况,包括手术时间、术中出血量、手术情况、术后并发症和生存情况等。结果 38例均顺利完成,完全切除(R0)切除率97%(37/38),R1切除率3%(1/38),中位手术时间413(210~520)min,术中出血量320(50~1 100)ml,淋巴结清扫数15(2~24)个。术后住院时间20(7~36)d,术后并发症发生率42%(16/38),其中胰瘘8例、胆瘘2例、术后感染6例。术后生存时间25(3~42)个月,无瘤生存时间14(5~28)个月。结论采取机器人辅助胰头十二指肠切除术切除胰头部恶性肿瘤安全、可行。
Objective To investigate the clinical value of robotic-assisted pancreatoduodenectomy in the treatment of pancreatic head malignancies. Methods The clinical data of 38 patients with pancreatic head malignancy treated with da Vinci robot assisted pancreatoduodenectomy in Shanghai Ruijin Hospital from May 2010 to April 2014 were retrospectively analyzed. Including 25 males and 13 females; mean age (59 ± 10) years. All patients signed informed consent, in line with medical ethics rules. Three “Trocar” robots and one Trocar and one auxiliary Trocar were inserted into the “five-hole method” and placed in the robot arm. The robot assisted the pancreaticoduodenectomy. Perioperative observation of patients with the situation, including operation time, intraoperative blood loss, surgical conditions, postoperative complications and survival. Results All 38 cases were successfully completed. The resection rate was 97% (37/38) for complete resection (R0) and 3% (1/38) for R1 resection rate. The median operative time was 413 (210-520) min and the intraoperative blood loss was 320 (50 ~ 1 100) ml, the number of lymph node dissection 15 (2 ~ 24) months. The postoperative hospital stay was 20 (7 ~ 36) d, and the incidence of postoperative complications was 42% (16/38), of which 8 were pancreatic fistula, 2 were biliary fistula and 6 were postoperative infection. Postoperative survival time 25 (3 ~ 42) months, free survival time 14 (5 ~ 28) months. Conclusion It is safe and feasible to use the robot-assisted pancreaticoduodenectomy to remove the pancreatic head malignancy.