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投稿时间：2023-07-11 网络发布日期：2024-04-20
投稿时间：2023-07-11 网络发布日期：2024-04-20
中文摘要: 目的 探讨达芬奇机器人胰十二指肠切除术（RPD）治疗壶腹周围癌（PAC）的临床应用及效果。
方法 回顾性分析盐城市第一人民医院2021年12月至2023年6月收治的8例PAC患者（胰头腺癌5例，十二指肠腺癌2例，胆总管下段腺癌1例）的临床资料。男4例，女4例；年龄为（63±10）岁，均行RPD治疗。观察患者手术、术后、随访情况，随访时间截至2023年6月。
结果 （1） 手术情况：8例患者均顺利完成RPD，无中转开腹患者，手术时间（358±68）min，术中出血量（240±112）mL。仅1例患者输同种异体血。所有患者病理切缘阴性，均达到R0切除。（2） 术后情况：8例患者胃管拔除时间（3.6±1.1）d，术后首次进食时间（2.8±0.6）d，术后下床活动时间（2.6±0.4）d，术后住院时间（20.8±4.2）d。无二次手术和围手术期死亡。6例发生围手术期并发症，其中发生轻度胰漏4例次，胆漏1例次，胸、腹腔积液3例次，胃潴留1例次，小肠梗阻1例次，均经对症保守治疗后治愈。（3） 随访情况：8例患者均获中位时间10个月的随访，2例出现肿瘤复发转移，无复发转移6例；1例因肺栓塞死亡，7例术后进入辅助化疗程序，均生存，其生活状态良好。
结论 RPD治疗PAC安全、可行，可个体化、合理选择应用。其长期预后，需要大样本量、高质量的临床研究进行评估。
中文关键词: 壶腹周围癌 达芬奇机器人手术系统 机器人胰十二指肠切除术 微创手术
Abstract:Objective To investigate the clinical application and efficacy of Da Vinci robotic assisted pancreaticoduodenectomy (RPD) in treatment of periampullary carcinoma（PAC）.
Methods The clinical data of 8 patients with PAC (5 cases of pancreatic head adenocarcinoma, 2 cases of duodenal adenocarcinoma, and 1 case of adenocarcinoma of the lower bile duct) admitted to Yancheng First Peoples Hospital from December 2021 to June 2023 were retrospectively analyzed. There were 4 males and 4 females, aged (63±10) years，and all of them were treated with RPD. The patients status during and after operation, and at follow-up were observed, with the follow-up time until June 2023.
Results Eight patients successfully completed RPD, without any conversion to open surgery. The surgery time was (358±68) min, and the intraoperative blood loss was (240±112) mL. Only one patients received intraoperative allogeneic blood transfusion. All patients had negative pathological margins and achieved R0 resection. The time to gastric tube extraction, time to initial diet intake, time for getting out of bed and postoperative hospital stay of 8 patients were (3.6±1.1), (2.8±0.6), (2.6±0.4) and (20.8±4.2) days, respectively. There was no secondary operation and no perioperative death. Six cases had perioperative complications (some cases complicated with multiple complications), including 4 cases of mild pancreatic leakage, 1 case of biliary leakage, 3 cases of pleural or abdominal effusion,1 case of intestinal retention,and 1 case of gastric obstruction, all of which were cured after symptomatic conservative treatment. All 8 cases received a median follow-up of 10 months, with 2 cases experiencing tumor recurrence and metastasis, and 6 cases without recurrence and metastasis . One case died due to pulmonary embolism,and 7 cases entered the adjuvant chemotherapy procedure after surgery and all survived, with good living conditions.
Conclusion RPD is safe and feasible for the treatment of PAC,and can be applied individually and reasonably.However, long-term prognosis evaluation requires large-size, high-quality clinical studies.
keywords: Periampullary carcinoma Da Vinci surgical system Robot pancreaticoduodenectomy Minimally invasive surgery
文章编号： 中图分类号：R735 R656 文献标志码：A
基金项目:
引用文本：
李作安,张晓艳,徐立群,等.机器人胰十二指肠切除术治疗壶腹周围癌的临床效果[J].中国临床研究,2024,37(4):544-548.
李作安,张晓艳,徐立群,等.机器人胰十二指肠切除术治疗壶腹周围癌的临床效果[J].中国临床研究,2024,37(4):544-548.