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目的总结分析机器人辅助胰腺切除术中胰肠吻合术与胰胃吻合术的临床特点与手术技巧,分析比较两种吻合方式的优劣。方法回顾性分析2010年3月至2012年2月上海瑞金医院应用达芬奇机器人辅助手术系统行24例胰腺吻合术的临床资料。结果 24例胰腺吻合术均在达芬奇机器人辅助手术系统下完成,无中转开腹。其中男10例,女14例,平均年龄(48.58±13.31)岁,术中切除肿瘤平均大小(2.74±1.31)cm,胰管平均直径(3.58±1.69)mm,胰腺吻合口平均完成时间(57.71±13.10)min,其中行胰肠吻合术12例,胰胃吻合术12例,术后并发胰漏者9例(37.5%)、胰腺吻合口出血者2例(8.3%)、胃排空延迟者1例(4.2%),均经过保守治疗后康复。术后平均住院时间为(23.88±8.02)d,胰腺吻合口旁引流管留置时间为(18.83±7.23)d,肛门排气恢复时间为(2.38±1.24)d。进一步研究发现,与胰肠吻合术组比较,胰胃吻合术组吻合时间长、术后胰漏发生率较高(P<0.05),但两组术后住院时间、吻合口引流时间、肛门排气时间差异无统计学意义。结论在机器人辅助手术系统下完成胰胃吻合或胰肠吻合均是安全可行的,具体吻合方式的选择应综合考虑手术方式与外科医师的手术经验。
Objective To summarize and analyze the clinical features and technique of pancreaticojejunostomy and robotic pancreatectomy during robotic pancreatectomy, and analyze the advantages and disadvantages of the two methods. Methods The clinical data of 24 patients with pancreatic anastomosis from March 2010 to February 2012 in Shanghai Ruijin Hospital using Da Vinci robot assisted surgery system were retrospectively analyzed. Results 24 cases of pancreatic anastomosis were completed under the Leonardo da Vinci robot assisted surgery system without conversion to laparotomy. There were 10 males and 14 females, with an average age of (48.58 ± 13.31) years. The average size of the resected tumors was 2.74 ± 1.31 cm, the average diameter of the pancreatic duct was 3.58 ± 1.69 mm, and the mean time to complete pancreatic anastomosis was 57.71 ± 13.10) min, including 12 cases of pancreaticojejunostomy, 12 cases of pancreaticojejunostomy, 9 cases (37.5%) with pancreaticoduodenectomy and 2 cases (8.3%) of pancreatic anastomosis hemorrhage. The delayed gastric emptying 1 case (4.2%), after a conservative treatment of rehabilitation. The average postoperative hospital stay was (23.88 ± 8.02) d. The retention time of pancreatic anastomosis drainage tube was (18.83 ± 7.23) days, and the anal exhaust recovery time was (2.38 ± 1.24) days. Further study found that, compared with the pancreaticojejunostomy group, the anastomosis time was longer and the incidence of postoperative pancreatic leakage was higher (P <0.05), but the postoperative hospital stay, anastomotic drainage time, anus row Gas time difference was not statistically significant. Conclusions It is safe and feasible to perform pancreaticojejunostomy or pancreaticojejunostomy under the robot assisted surgery system. The specific method of anastomosis should be considered in combination with the operation experience of the surgeon.