摘要
目的:总结完全脏器转位患者达芬奇机器人手术过程中的优势和困难，探索达芬奇机器人手术对于完全脏器转位患者行胰十二指肠切除的可行性及安全性。方法:完全性全身脏器转位(situs inversus totalis，SIT)是一种极为少见的先天性解剖异常，其胸腹脏器正常的解剖位置呈镜像反转。由于解剖结构的变化，对于SIT患者在患有胸腹腔脏器肿瘤手术时，外科医师面临着一个巨大的挑战。达芬奇(da Vinci)手术机器人系统于20世纪末问世，该手术系统在胰腺微创外科手术中的优势越来越明显，更多地应用于临床，并取得了良好效果。2022年10月，解放军总医院第一医学中心肝胆胰外科医学部收治了一例SIT患者，经过完善术前检查，诊断为胰腺头部癌并梗阻性黄疸，术前充分评估之后，给予达芬奇机器人(Da Vinci Si)胰十二指肠切除术。结果:术后恢复良好，随访无明显并发症发生。结论:SIT患者达芬奇机器人手术过程中存在很多优势，但依然面临一些困难，通过对本例患者的诊治过程，证明了达芬奇机器人手术对于SIT患者行胰十二指肠切除的可行性及安全性。
Abstract
Objective:To summarize the advantages and difficulties of da Vinci robotic surgery in patients with complete organ transposition, and to explore the feasibility and safety of da Vinci robotic surgery for pancreaticoduodenectomy in patients with complete organ transposition.Methods:Situs inversus totalis (SIT) is a rare congenital anatomic anomaly in which the normal anatomic position of the thorax and abdomen presents a mirror inversion. Therefore, surgeons face a great challenge when operating on patients with thoracic and abdominal organ tumors due to anatomical changes. Da Vinci robotic surgical system came out at the end of last century. The advantages of this surgical system in minimally invasive pancreatic surgery are becoming more and more obvious, and more and more clinical applications have achieved good results. In Oct. 2022, a patient with complete organ transposition was admitted to the Department of Hepatobiliary and Pancreatic Surgery of the First Medical Center of the Chinese People′s Liberation Army General Hospital. After complete preoperative examination, the patient was diagnosed as pancreatic head cancer with obstructive jaundice. After adequate preoperative evaluation, the da Vinci Si pancreaticoduodenectomy was performed.Results:Postoperative recovery was good, no obvious complications occurred during follow-up.Conclusions:There are many advantages in da Vinci robotic surgery for patients with complete organ transposition, but there are still some difficulties. Through the diagnosis and treatment process of this patient, the feasibility and safety of da Vinci robotic surgery for pancreaticoduodenectomy in patients with complete organ transposition are proved.
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