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目的:探讨机器人辅助前正中入路肝尾状叶肿瘤切除的手术技术及临床应用,提出微创肝脏手术的新入路。方法:分析2012年11月我院于机器人手术系统(da Vinci S)辅助下完成的1例前正中入路肝尾状叶肿瘤切除术,术前CT血管造影图像建立肝脏3D模型,确定经肝正中裂前入路行尾状叶肿瘤切除的手术方案。结果:病人男性,78岁。完全机器人辅助顺利完成手术。完整切除肿瘤。手术时间360 min,术中出血300 mL,无术中、术后输血。术后病理为肝细胞癌。未发生术后并发症,术后28天出院,随访至今1年余,恢复良好。结论:肝正中裂前入路可提高肝尾状叶肿瘤的手术切除率,保留更多的正常肝组织。在精确的术前评估后,机器人手术系统下肝尾状叶肿瘤切除术安全、可行。
Objective: To explore the surgical technique and clinical application of robot assisted anterior approach to the resection of hepatic caudate lobe tumor, and to propose a new approach to minimally invasive liver surgery. METHODS: One case of anterior anterior approach hepatic caudate lobe tumor resection assisted by da Vinci S in our hospital was analyzed in November 2012. Preoperative CT angiography was performed to establish a 3D model of liver. The median approach to the line before the caudate lobe tumor resection of the surgical options. Results: The patient was male, 78 years old. Complete robot assisted the successful completion of surgery. Complete removal of the tumor. The operation time was 360 min, intraoperative blood loss was 300 mL, no intraoperative and postoperative blood transfusion. Postoperative pathology of hepatocellular carcinoma. No postoperative complications occurred. The patients were discharged at 28 days postoperatively and recovered more than one year after the visit. Conclusion: The approach of anterior approach to the middle liver can improve the surgical resection rate of the caudate lobe tumor and retain more normal liver tissue. After accurate preoperative assessment, robotic surgery system resection of the caudate lobe tumor resection is safe and feasible.