摘要
目的 对比单极电剪与超声刀在达芬奇机器人辅助胰体尾切除术中的应用效果.方法 回顾分析2020年7月至2023年12月在徐州医科大学附属医院普通外科接受达芬奇机器人辅助胰体尾切除术的31例术前诊断为胰体尾良性占位性病变患者资料,其中男性9例,女性22例,年龄(54.4±15.7)岁.31例患者中行达芬奇机器人辅助胰体尾切除术且术中使用单极电剪的纳入单极电剪组(n=12),单极电剪自带多关节可灵活旋转的机械臂,完成解剖及分离操作;使用超声刀的纳入超声刀组(n=19),超声刀完成解剖及分离操作.比较两组手术时间、术中出血量、保脾率、术后排气时间、术后住院时间、术后并发症(胰瘘、出血等)及住院总费用等指标.结果 术后病理证实31例患者中胰腺浆液性囊腺瘤6例(19.4％)、胰腺黏液性囊腺瘤5例(16.1％)、胰腺神经内分泌肿瘤3例(9.7％)、胰腺实性假乳头状瘤6例(19.4％)、胰腺囊肿5例(16.1％)、胰腺良性囊性病变3例(9.7％)、不易分类3例(9.7％).所有患者手术均顺利完成,均无中转开腹及死亡患者.两组手术时间、术中出血量、保脾率、术后住院时间、住院总费用等比较,差异均无统计学意义(均P＞0.05).单极电剪组术后排气时间为(2.8±0.7)d,比超声刀组的(3.6±0.7)d更短,差异有统计学意义(t=-2.88,P=0.007).两组均无术后出血,单极电剪组共有4例术后出现并发症,均为胰瘘,其中生化漏2例,B级胰瘘2例;超声刀组有8例术后出现并发症,胰瘘7例,其中生化漏3例,B级胰瘘4例,另有腹腔感染3例,均予以对症治疗后痊愈.两组患者术后并发症发生率比较,差异无统计学意义(P=0.717).结论 达芬奇机器人辅助胰体尾切除时,应用单极电剪可以达到与超声刀同样的效果,并且能够充分发挥机器人手术系统的优势.
Abstract
Objective To compare the efficacy of monopolar electric scissors and harmonic scalpel in Da Vinci robot-assisted distal pancreatectomy.Methods A total of 31 patients undergoing Da Vinci robot-assisted distal pancreatectomy at the Affiliated Hospital of Xuzhou Medical University from July 2020 to December 2023 were included.There were 9 males and 22 females,aged(54.4±15.7)years.Thirty-one patients who underwent Da Vinci robot-assisted distal pancreatectomy by monopolar electric scissors were included in the monopolar electric scissors group(n=12),with a multi-joint flexible rotating mechanical arm to complete the dissection and separation and the other were inducled in harmonic scalpel group(n=19).Operation time,intraoperative blood loss,spleen preservation,postoperative exhaust time,postopera-tive hospital stay,postoperative complications and total hospitalization cost were compared between the two groups.Results Postoperative pathology confirmed that among the 31 patients,there were 6 cases(19.4％)serous cystadenomas,5 cases(16.1％)mucinous cystadenomas,3 cases(9.7％)pancreatic neuroendo-crine tumors,6 cases(19.4％)solid pseudopapilloma,5 cases(16.1％)pancreatic cysts,and 3(9.7％)benign cystic lesions,3 cases(9.7％)were not easily classified.All the operations were success-fully completed without conversion to laparotomy or death.There were no significant differences in operation time,intraoperative blood loss,splenic preservation rate,postoperative hospital stay and total hospitalization cost between the two groups(all P＞0.05).The exhaust time in the monopolar electric scissors group was(2.8±0.7)d,which was shorter than that in the harmonic scalpel group(3.6±0.7)d,and the difference was statistically significant(t=-2.88,P=0.007).There was no postoperative bleeding in both groups.In the monopolar electric scissors group,there were 4 cases of postoperative complications,all of which were pancreatic fistula,including 2 cases of biochemical leakage and 2 cases of B-grade pancreatic fistula.In the harmonic scalpel group,8 cases had postoperative complications,7 cases of pancreatic fistula,including 3 cases of biochemical leakage,4 cases of B-grade pancreatic fistula,and 3 cases of abdominal infection,which were cured after treatment.There was no significant difference in the incidence of postoperative com-plications between the two groups(P=0.717).Conclusion The application of monopolar electric scissors in Da Vinci robot-assisted distal pancreatectomy could be safe and feasible in experienced hands,which could also utilize the advantages of robot system.
NETL
NSTL
万方数据