摘要
目的：探讨机器人辅助腹腔镜肝切除术的优势。方法35例患者，包括原发性肝癌14例，肝内外胆管结石13例和良性肿瘤8例，实施机器人辅助腹腔镜肝切除术。结果本组实施左肝外叶切除5例，规则性左半肝切除16例，右半肝切除6例，局部肝切除6例，中肝切除（Ⅳ、Ⅴ、Ⅷ段）1例，特殊部位肝切除（尾状叶）1例，联合胆道探查、T管引流10例，胆肠吻合、肝十二指肠韧带淋巴结骨骼化清扫1例。手术时间105～560 min[（279．26±98．85）min]，术中出血量50～2000 ml [（408．86±506．68）ml]，输血率14．29％（5／35），术后住院时间4～18 d，平均13 d。其中1例因肝静脉主干撕裂出血较多中转开腹。术后有1例发生胆漏，余3例发生肝断面积液，均经保守治疗后痊愈，无死亡病例。14例肿瘤患者切缘均为阴性，随访5～42月，1例术后5月复发死亡，4例复发带瘤生存，9例无复发。结论机器人辅助腹腔镜肝切除安全可行。
Abstract
Objective To explore the advantages of robotic-assisted laparoscopic hepatectomy.Methods Thirty-five pa-tients, including 14 cases with primary liver cancer, 13 cases with intrahepatic or extrahepatic bile stones and 8 cases with benign tumor, underwent robotic-assisted laparoscopic hepatectomy.Results The operations included the left lateral liver resections ( n =5), the left liver anatomical resections (n =16), the right liver anatomical resections (n =6), the partial liver resection (n =6), the liverⅣ,ⅤandⅧsegments resections (n =1), the special site liver resection (caudate lobe) (n =1) and the combined bile duct exploration and T tube drainage (n =10) as well as the biliary intestinal anastomosis plus hepatoduodenal ligament bone lymph node cleaning (n =1).The average operation time was 105~560 min [(279.26 ±98.85)min].The intraoperative blood loss was 50~2000 ml [(408.86 ±506.68)ml].The blood transfusion rate was 14.29% (5/35).The hospitalization time was 4~18 days with a mean of 13 days.One patient was converted to open operation due to large hemorrhoea induced by hepatic vein laceration ( con-version rate 2.86%).There were 1 case with biliary leakage and 3 cases with cut surface effusion after operation.All the patients were treated with conservative therapy and discharged after recovery.No death occurred during perioperative period.Cutting edges were neg-ative for 14 tumor patients.All cancer patients were followed-up for 5~42 months.During the follow-up period, 1 case was dead of recurrence in 5 months after operation, 4 cases of survival with tumor recurrence, and 9 cases without recurrence.Conclusion The robot assisted laparoscopic liver resection is a safe and feasible procedure.
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维普
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