摘要
目的:探讨机器人手术在困难子宫切除术中的应用价值与手术技巧。方法:回顾性分析2021年4月至2023年6月于解放军总医院第七医学中心由同一术者实施的困难子宫切除术病例资料，描述患者的人口统计学特征、切除子宫参数、术中术后情况等临床数据。结果:纳入的24例患者平均年龄为47.50岁，平均体质量指数(body mass index，BMI)为24.62 kg/m2，11例有腹部手术史，5例有肌瘤剔除史。术前评估子宫大小超出孕16周的患者占66.67%，术后测量子宫平均重量为752.58 g，最重者达2650 g。全部患者中位手术时间136.50 min，中位出血量150 ml, 1例患者中转开腹，患者术后均1～2 d排气，术后平均住院5.63 d。4例患者出现术后并发症，分别为阴道残端出血、气胸、下肢肌间血栓和残余卵巢综合征，无泌尿系和肠道损伤。结论:机器人手术具有清晰放大的3D视野、灵活有力的机械臂和滤过震颤功能，在视野放大效果、操作的灵活性和稳定性上带来了革新，有助于降低出血量、减少并发症、加速术后恢复，因此在困难子宫切除中具有一定优势。
Abstract
Objective:To discuss the application value of robotic-assisted surgery in difficult hysterectomy and summarize the surgical technique.Methods:We retrospectively analyzed the hysterectomy cases performed by the same surgeon in the Seventh Medical Center of Chinese PLA General Hospital from Apr. 2021 to Jun. 2023. Clinical data such as demographic characteristics, parameters of uteri, and intraoperative and postoperative details was described.Results:The average age of 24 patients was 47.50 years and the average BMI value was 24.62 kg/m2. 11 patients had a history of abdominal surgery and 5 had a history of myomectomy. 66.67% of the patients were found uterine size exceeding 16 weeks of pregnancy before surgery, and the average weight of the uteri measured after surgery was 752.58 g, with the maximum weight reaching 2650 g. The median operation time of all patients was 136.50 min, and the median bleeding volume was 150 ml. Only 1 patient was converted to laparotomy. The postoperative venting time was 1-2 days, and the mean length of postoperative hospital stay was 5.63 days. The complications in 4 patients included vaginal stump bleeding, pneumothorax, lower limb intermuscular thrombosis and residual ovarian syndrome. No patient had urinary and intestinal injuries.Conclusions:Surgical robot has a clear and enlarged 3D field of view, a flexible and powerful robotic arm with the function of filtering tremors, which brings innovations in field of view amplification, operational flexibility and stability. It could help to decrease blood loss, reduce complications and accelerate postoperative recovery, so it has certain advantages in difficult hysterectomy.
万方数据