程序化达芬奇机器人“3+2”模式“七步法”远端胃癌根治术

Programmed “seven-step method” in distal radical gastrectomy with Da Vinci robot “3+2” mode

  • 摘要:
      目的  介绍程序化达芬奇机器人“3+2”模式远端胃癌根治手术清扫“七步法”。
      方法  回顾性分析2017年6月至2020年6月于甘肃省人民医院完成全腔镜下达芬奇机器人远端胃癌根治术的患者100例。手术分七步:1)建立戳孔,腹腔探查,悬调肝脏,摆体位,连接机器;2)右侧大弯侧区域及幽门下区域(4d,6);3)幽门上区域,离断十二指肠,清扫肝十二指肠韧带(5,12a);4)胰腺前方区域(7,8a,8p,9,11p);5)小弯侧区域(1,3);6)左侧胃大弯区域(4sb);7)离断胃标本,近端胃和空肠吻合。
      结果  全部患者无中转开腹,术中无输血。手术时间 (175.0±16) min,出血量(99±36.4)mL,淋巴结清扫数目(30.3±2.5)枚,机器人相关费用(22 794±3 660)元。并发症发生5例,其中肠梗阻2例,腹腔内出血1例、伤口感染1例以及胃排空延迟1例,均采用保守方法治愈。未出现吻合口狭窄及吻合口瘘。
      结论  本程序化方法安全可行,重复性好,手术时间相对较短,费用相对较低。该程序化方法有利于新开展机器人手术的机构培养手术团队、缩短学习曲线、降低手术难度,从而更好地服务于临床教学工作。

     

    Abstract: Objective : To introduce a programmed “seven-step method” in remote radical gastrectomy with Da Vinci robot “3+2”mode. Method : This retrospective analysis included 100 patients who underwent Da Vinci robotic distal gastrectomy at Gansu Provincial Hospital from June 2017 to June 2020. The surgery was performed in seven steps: 1) docking, abdominal exploration, hanging the liver, posing, and connecting machine; 2) right side of the greater curvature of the stomach and inferior pylorus area (4d, 6); 3) superior pyloric region, detaching the duodenum, and clearing the hepatoduodenal ligament (5, 12a); 4) anterior region of the pancreas (7, 8a, 8p, 9, 11p); 5) small curvature area of the stomach (1, 3); 6) left side of the greater curvature of the stomach (4sb); and 7) dissecting the stomach specimen and anastomosis of the proximal stomach and jejunum. Results : All patients did not have surgical conversion or blood transfusion during the operation. The operation time was (175.0±16) min, bleeding amount was (99±36.4) mL, number of lymph node dissection was (30.3±2.5), and cost of the Da Vinci system was (22, 794±3, 660) Yuan. Complications occurred in five cases: two cases of intestinal obstruction, one of intraperitoneal hemorrhage, one of wound infection, and one of delayed gastric emptying. All cases were cured following conservative methods. No anastomotic stenosis or anastomotic fistula was noted. Conclusions : This model method is safe, feasible, and reproducible and has a short operation time and low cost. The patterning method is beneficial for training operation teams, shortening learning curves, and reducing operation difficulty to better serve clinical teaching.

     

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