摘要
目的总结达芬奇机器人手术系统在高龄重度梗阻性黄疸患者中的治疗经验。方法第二炮兵总医院肝胆胃肠病研究所在2009年1月至2011年5月期间共行机器人手术209例,其中高龄重度梗阻性黄疸患者47例(机器人组),同期开腹手术患者44例(开腹组),对比观察患者疾病分布,术前、术中及术后等相关指标,对其结果进行归纳分析。结果 2组患者基线一致(P>0.05)。机器人组46例在机器人辅助下完成手术,手术完成率达97.87%(46/47),1例中转开腹,中转率为2.13%(1/47);手术方式包含肝胆胰外科所有手术方式,且其中1例肝门部胆管癌患者因血清胆红素水平极高(375μmol/L),急诊行肝门部胆管癌切除+肝门-空肠Roux-en-Y吻合术;术后有7例患者出现并发症,总体并发症发生率为14.89%(7/47);围手术期死亡1例,死亡率为2.13%(1/47);术后3个月生存率为78.15%;术后15 d和术后3个月体力状况评分分别为42.87±18.61和58.51±23.86;腹部切口总长度为(6.30±1.70)cm。开腹组所有患者均完成手术,其中急诊手术4例;术后13例患者出现并发症,总体并发症发生率为29.55%(13/44),围手术期死亡2例,死亡率为4.55%(2/44);术后3个月生存率为72.36%;术后15 d和术后3个月体力状况评分分别为37.15±13.64和45.27±18.96;腹部切口总长度为(26.73±3.07)cm。2组总体并发症发生率、术后15 d和术后3个月体力状况评分及切口总长度比较,差异均有统计学意义(P<0.05)。结论达芬奇机器人手术系统对于高龄重度梗阻性黄疸患者的治疗是安全、有效的,其创伤小,操作灵活精准,术后恢复快,拓展了外科手术的年龄界限,扩大了手术适应人群。
Objective To summarize the clinical experience of da Vinci surgical system in treatment for senile patients with severe obstructive jaundice.Methods From January 2009 to May 2011,209 patients with hepatopancreatobiliary（HPB） diseases underwent robotic surgeries by using da Vinci surgical system.Forty-seven senile patients with severe obstructive jaundice were selected for robotic surgery（robot group） and 44 for open surgery（open group）.The distribution of disease,pro-,intra-,and post-operative data in the two groups were analyzed.ResultsBaseline of two groups was same.A total of 46 patients had underwent total robotic surgeries（97.87%,46/47） and 1 patient converted to hand-assisted procedure（2.13%,1/47）.Surgeries included all HPB difficult surgical procedures,also including 1 case of hilar cholangiocarcinoma patient who had high level serum bilirubin（375μmol/L）and underwent emergency resection for hilar cholangiocarcinoma and portal-jejunal Roux-en-Y anastomosis.Postoperative complications occurred in 7 cases（14.89%,7/47） and 1 case died（2.13%,1/47）.Three-month survival rate was 78.15%.Fifteen-day and 3-month after surgery,physical strength score was 42.87±18.61 and 58.51±23.86,respectively.The total length of abdominal incision was（6.30±1.70） cm.All the patients in the open group completed surgery,including emergency operation in 4 cases.Postoperative complications occurred in 13 cases（29.55%,13/44） and 2 cases died（4.55%,2/44）.Three-month survival rate was 72.36%.Fifteen-day and 3-month after surgery,physical strength score was 37.15±13.64 and 45.27±18.96,respectively.The total length of abdominal incision was（26.73±3.07） cm.There were significant differences of postoperative complications,postoperative 15-day and 3-month physical strength score,and incision length between two groups（P0.05）.Conclusionsda Vinci surgical system is safe and effective in treatment for senile patients with severe obstructive jaundice.
出处
《中国普外基础与临床杂志》
CAS
2012年第2期171-176,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
达芬奇机器人手术
高龄
重度梗阻性黄疸
微创
肝胆胰外科
da Vinci surgical system
Senile
Severe obstructive jaundice
Minimally invasive
Hepatobiliary pancreatic surgery
