摘要
目的探索机器人手术系统对肝移植术后胃癌患者行根治手术的可行性和安全性。方法2018年10月23日在重庆陆军军医大学附属西南医院普通外科,应用达芬奇手术系统对1例65岁男性肝移植术后胃癌患者成功施行了D2根治性远端胃大部切除术。手术简要操作步骤:腹壁戳孔采用5孔法布局;探查腹膜无转移,大网膜上移包裹肝门部,肿瘤位于胃窦部近小弯侧;依次清扫第1、2站淋巴结;切除远端胃,在完全机器人系统下完成毕Ⅱ式+Braun吻合术。总结分析该例患者肝移植术后行机器人胃癌根治的术中情况,以及术后2个月的恢复情况。结果手术时间315 min,术中出血145 ml,共清扫淋巴结19枚,其中有11枚发现癌转移。由于手术难点在于精准分离肝门部的粘连,避免损伤肝脏面以及与之密切粘连的结肠升曲和十二指肠,并注意保护胆总管和门静脉,而灵活精巧的机器人手术系统的内镜腕关节,在解剖分离脏器间粘连、以及在分离肝总动脉裸化后失去正常血管鞘后形成的局部致密粘连过程中显示了明显优势。术后诊断:胃窦中分化腺癌pT4aN3aM0,ⅢB期。术后第3天经口进半流质饮食。免疫抑制剂在手术后第3天恢复服用。第6天拔出腹腔引流管,第7天出院。无腹腔出血、切口感染、吻合口漏、吻合口狭窄等并发症。患者术后2个月来饮食起居正常。结论机器人手术系统对肝移植术后胃癌手术是安全可行的。
Objective To explore the feasibility and safety of robotic surgical system for radical gastrectomy after liver transplantation.Methods A 65-year-old male patient with gastric cancer after liver transplantation underwent radical distal subtotal gastrectomy using Da Vinci surgical system at the General Surgery Department of Southwest Hospital Affiliated to the Army Military Medical University on October 23,2018.The placement of Trocars was arranged using five-hole method.No metastatic tumors were found during intraperitoneal exploration and the first hepatic hilum was found to be wrapped with omentum majus.The tumor located at gastric antrum near the lesser curvature.Then the first and the second station lymph nodes were dissected successively.Distal gastrectomy,BillrothⅡand Brown anastomosis were performed.The anatomical changes of upper abdomen and gastric lymph reflux after liver transplantation were analyzed.Results Radical distal gastrectomy with D2 lymphadenectomy was successfully performed under the whole robotic surgical system.The operative time was 315 minutes,and blood loss was 145 ml.A total of 19 lymph nodes were dissected,of which 11 were metastatic lymph nodes.The operative difficulty was to separate the adhesion around the hepatic hilum precisely so as to avoid the damage of hepatic surface,as well as the colon hepatic flexure and duodenum which were closely adhered to hepatic hilum.Meanwhile,it was necessary to pay attention to protetion for the common bile duct and portal vein.The endoscopic wrist joint of the robot surgical system was flexible and delicate,which had obvious advantages in the process of anatomical separation of the adhesions among organs and adhesions around denuded common hepatic artery without normal vascular sheath.Semi-liquid diet was provided on the third day after operation.The immunosuppressants were resumed on the third day after operation.The patient was discharged on the 7th day postoperatively without any complications.There were no abdominal bleeding,incision infecti
作者
钱锋
陈倩
刘军言
樊俊彦
李川
刘佳佳
Qian Feng;Chen Qian;Liu Junyan;Fan Junyan;Li Chuan;Liu Jiajia(Department of General Surgery,Southivest Hospital,Military Medical University,Chongqing 400038,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第2期180-184,共5页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金面上项目(81773074).
关键词
达芬奇机器人手术系统
胃肿瘤
胃切除术
肝移植术后
Da vinci robotic surgical system
Stomach neoplasms
Gastrectomy
Liver transplantation
