摘要
目的探讨机器人在保留脾脏的远端胰腺切除术中的应用价值。方法回顾性分析自2015年5月至2020年8月于中山大学附属第一医院胆胰外科行机器人辅助保留脾脏远端胰腺切除术病人的临床资料,分析围手术期相关临床病理资料及术后转归情况。结果共有46例术前拟行机器人辅助保留脾脏远端胰腺切除术的病人入组研究,其中男性15例、女性31例,中位年龄42(32~56)岁。最终39例病人完成机器人辅助保留脾脏的远端胰腺切除术,保脾成功率为84.8%;另有6例病人行机器人辅助联合脾脏切除的远端胰腺切除术;中转开腹1例,中转率2.2%。中位手术时长为270(218~323)min。中位术中失血量为50(30~63)mL。所有病人均获得完整切除。术后6例并发临床相关胰瘘(均为B级胰瘘、无C级胰瘘),腹腔感染4例,胃排空延迟1例,均经保守治疗后痊愈。无术后死亡病例。中位术后住院时间为8(7~11)d。术后病理学检查结果显示,24例为胰腺神经内分泌肿瘤,21例为胰腺囊性肿瘤(包括10例浆液性囊腺瘤、3例黏液性囊腺瘤、5例实性假乳头状瘤、3例导管内乳头状黏液性肿瘤)、1例为慢性胰腺炎。结论机器人辅助保留脾脏的远端胰腺切除术是一种安全可靠的微创手术方式。
Objective To explore the usefulness of robot-assisted surgery in spleen-preserving distal pancreatectomy by analyzing data in our center retrospectively.Methods Data of patients who underwent robot-assisted spleenpreserving distal pancreatectomy in the First Affiliated Hospital of Sun Yat-sen University from May 2015 to August2020 were collected.The clinicopathological data and postoperative outcome of the patients were retrospectively analyzed.Results A total of 46 patients who were planned to undergo robotic-assisted spleen-preserving distal pancreatectomy before surgery were enrolled in this study,including 15 males and 31 females,with a median age of 42(32~56)years.Finally,39 patients underwent robot-assisted spleen-preserving distal pancreatectomy,with the spleen preservation rate of 84.8%.Another 6 patients underwent robot-assisted distal pancreatectomy combined with splenectomy.1 case was converted to laparotomy,with the conversion rate of 2.2%.The median operative time was 270(218~323)min.The median intraoperative estimated blood loss was 50(30~63)m L.All the patients received completely resection.There were 6 cases of clinically relevant postoperative pancreatic fistula(all were grade B pancreatic fistula,no grade C pancreatic fistula),4 cases of abdominal infection,and 1 case of delayed gastric emptying.All patients recovered after conservative treatment.No postoperative deaths occurred.The median postoperative length of stay was 8(7~11)days.Pathological results showed that 24 cases were pancreatic neuroendocrine tumors,21 cases were pancreatic cystic neoplasms(including 10 cases of serous cystadenoma,3 cases of mucinous cystadenoma,5 cases of solid pseudopapillary tumor,and 3 cases of intraductal papillary mucinous tumors),1 case was chronic pancreatitis.Conclusion Robot-assisted distal pancreatectomy offers a high spleen preservation rate,which can preserve the spleen function on the basis of tumor resection.It is a safe and reliable minimally invasive surgery method.
作者
黄锡泰
蔡建鹏
陈伟
房鹏
陈流华
殷晓煜
HUANG Xi-tai;CAI Jian-peng;CHEN Wei(Department of Pancreatobiliary Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第12期1407-1409,1422,共4页
Chinese Journal of Practical Surgery
基金
国家自然科学基金面上项目(No.81772522)。
关键词
机器人手术
保留脾脏的远端胰腺切除术
胰腺肿瘤
robot-assisted surgery
spleen-preserving distal pancreatectomy
pancreatic neoplasms
