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目的探讨达芬奇外科系统肝脏肿瘤切除术的可行性、安全性及优势。方法回顾性分析瑞金医院普外科2010年3月30日至2013年8月15日期间进行的21例达芬奇外科系统肝脏肿瘤切除术患者的临床资料。结果 21例肝脏肿瘤患者中原发性肝癌13例,肝脏再生结节1例,转移性腺癌2例,肝脏平滑肌肉瘤2例,肝脏血管瘤3例。21例达芬奇外科系统肝脏肿瘤切除术的手术时间为(156.67±92.19)min(60~480 min);术中出血量为(585.71±1 076.12)mL(50~5 000 mL);术中输血4例(19.05%);中转手术共3例(14.29%),其中1例中转开腹(4.76%),2例中转为手助式腹腔镜(9.52%)。无术中并发症发生;术后并发胆瘘、腹腔感染各1例,均经保守治疗后痊愈。术后进餐时间为(3.23±1.26)d(2~6 d);术后住院时间为(10.10±9.02)d(5~47 d)。无二次手术及围手术期死亡患者。结论本研究入组的患者肿瘤类型多样,肿瘤位置复杂,操作难度较大,其结果提示达芬奇外科系统在肝脏肿瘤切除术中是安全、可靠的,且在很大程度上拓宽了腹腔镜下肝脏肿瘤切除术的适用范围。
Objective To explore the feasibility, safety and advantages of liver resection in Da Vinci’s surgical system. Methods The clinical data of 21 patients undergoing liver resection of the DaVinci surgical system during the general surgery of Ruijin Hospital from March 30, 2010 to August 15, 2013 were retrospectively analyzed. Results Of the 21 liver tumors, 13 were primary liver cancer, 1 was liver regenerative nodule, 2 was metastatic adenocarcinoma, 2 was liver leiomyosarcoma, and 3 was hepatic hemangioma. The surgical time of liver resection in 21 Da Vinci surgical systems was (156.67±92.19) min (60-480 min); the intraoperative blood loss was (585.71±1 076.12) mL (50-5000 mL); There were 4 cases (19.05%) of blood transfusions, 3 cases (14.29%) of transfer operations, 1 case converted to open surgery (4.76%), and 2 cases converted to hand-assisted laparoscopy (9.52%). No intraoperative complications occurred; postoperative concurrent bile fistula and intra-abdominal infection occurred in 1 patient and all recovered after conservative treatment. Postoperative meal time was (3.23±1.26) days (2-6 days); postoperative hospital stay was (10.10±9.02) days (5-47 days). No secondary surgery and perioperative death. Conclusions The patients enrolled in this study have diverse tumor types, complex tumor locations, and difficult procedures. The results suggest that Da Vinci’s surgical system is safe and reliable in liver tumor resection, and has greatly broadened the scope of laparoscopy. The scope of application of liver tumor resection.