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目的探讨机械臂辅助3D系统在完全腹腔镜胃癌D2根治术中的临床应用,评估其安全性和可行性。方法回顾性分析2014年10月至2015年8月广东省中医院胃肠外科应用机械臂辅助3D系统实施完全腹腔镜胃癌D2根治术18例。分析患者基线资料、术中及术后结果。结果18例患者均完成3D腹腔镜手术。1例胃体癌患者行全胃切除术时术中因脾脏撕裂出血,中转为手助扶镜并顺利完成手术。术后并发症发生率为11.2%,包括1例(5.6%)肺部感染和1例(5.6%)炎性肠梗阻,均经保守治疗后痊愈出院。远端胃癌D2根治术平均手术时间为(232.8±58.3)min,全胃切除D2根治术平均手术时间为(287.3±67.9)min,术中失血量为(122.5±55.7)ml,首次排气时间为(47.9±19.7)h,恢复流质饮食时间为(74.6±20.9)h,术后住院时间为(10.2±4.7)d。平均淋巴结清扫数目为(29.8±11.3)枚。结论机械臂辅助系统在完全3D腹腔镜胃癌D2根治术中的临床应用是安全、可行的。
Objective To investigate the clinical application of robotic-assisted 3D system in D2 radical resection of complete laparoscopic gastric cancer and evaluate its safety and feasibility. Methods Retrospective analysis of 18 cases of complete laparoscopic gastric cancer with D2 radical mastectomy using a robotic arm assisted 3D system in Guangdong Provincial Hospital of Traditional Chinese Medicine from October 2014 to August 2015 was retrospectively analyzed. Analysis of patient baseline data, intraoperative and postoperative results. Results All the 18 patients underwent 3D laparoscopic surgery. One case of gastric cancer patients undergone total gastrectomy due to splenectomy bleeding surgery, transfer to hand-assisted mirror and successfully complete the operation. The postoperative complication rate was 11.2%, including 1 case (5.6%) of pulmonary infection and 1 case (5.6%) of inflammatory intestinal obstruction. All patients were cured after conservative treatment. The average operation time of D2 radical mastectomy for distal gastric cancer was (232.8 ± 58.3) min, and the average operation time of D2 mastectomy was (287.3 ± 67.9) min. The blood loss was (122.5 ± 55.7) ml, (47.9 ± 19.7) h, the time of restoring the liquid diet was (74.6 ± 20.9) h, and the postoperative hospital stay was (10.2 ± 4.7) days. The average number of lymph node dissection was (29.8 ± 11.3) pieces. Conclusion The clinical application of the arm assist system in the complete 3D radical D2 laparoscopic gastric cancer treatment is safe and feasible.