摘要
目的:总结流域学说指导下开展机器人肝脏肿瘤靶域切除技术的经验和技术要点。方法:回顾性分析2021年10月至2022年12月笔者团队62例采用机器人肝脏肿瘤靶域切除术患者资料。术前进行靶域分析、结合肿瘤生物学特性确定靶域切除范围，术中循个体化解剖标志施行肿瘤靶域切除。结果:62例患者均顺利完成手术，其中左半肝加尾状叶切除3例、右肝加尾状叶切除1例、左肝肿瘤切除12例、中肝肿瘤切除7例、右肝肿瘤切除35例、尾状叶肿瘤切除4例，无中转开腹手术。手术时间、术中出血量的中位数分别为188 min(70～510 min)、50 mL(5～1 100 mL)。术中大出血(≥800 mL)2例。术后出现胆漏2例，均非手术治疗痊愈。术后住院时间中位数为7 d(3～28 d)。无二次手术及死亡病例。结论:肝脏肿瘤靶域切除技术是安全可行的，以肿瘤生物学特性为核心，个体化解剖标志为导向，外科机器人和多种技术的综合应用有助于靶域切除技术的实施。
Abstract
Objective:To summarize the experience and technical points of the robotic target-territory resection techniques for liver tumors target resection technology under the guided by the watershed theory.Methods:A retrospective analysis was performed for the data of 62 patients in the author′s team who underwent robotic target-territory resection of liver tumors from Oct. 2021 to Dec. 2022. target-territory analysis was carried out before surgery, the target-territory resection extent based on the biological characteristics of the tumor, and the resection was performed according to individual anatomical markers during surgery.Results:All 62 patients successfully completed the operation, including 3 cases of left hemiliver plus caudate lobectomy, 1 case of right liver plus caudate lobec, 12 cases of left liver tumor resection, 7 cases of middle liver tumor resection, 35 cases of right liver tumor resection, 4 cases of caudate lobe tumor resection, and no laparotomy. The duration of surgery and the median intraoperative bleeding were 188 min(70-510 min) and 50 mL(5-1 100 mL), Intraoperative hemorrhage (≥800 mL) was 2 cases. There were 2 cases of bile duct leakage after surgery, both of which were cured without surgical treatment. The median length of hospital stay after surgery was 7 d(3-28 d). There were no secondary surgeries or deaths.Conclusions:Target-territory resection technology of liver tumor is safe and feasible. It is based on the biological characteristics of tumor, and individualized anatomic landmarks play an important role. The comprehensive application of surgical robots and various technologies will help the implementation of target-territory resection.
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