机器人辅助手术系统在乳腺癌治疗中的应用及前景

doi:10.16139/j.1007-9610.2024.05.02

摘要/Abstract

摘要：

近年来，以腔镜技术和机器人手术系统为代表的微创外科技术成为外科治疗发展的新趋势。机器人手术具有精准、微创、美观等优势，在乳腺外科领域得到了越来越广泛应用。本文通过分析文献，综述了近年来机器人手术在乳腺癌治疗中的应用，包括技术的发展、手术的可行性、安全性等，为机器人手术系统在乳腺癌治疗中的应用提供理论依据。

关键词: 乳腺癌, 机器人手术系统, 乳房切除术, 淋巴结清扫

Abstract:

In recent years, minimally invasive surgical techniques represented by endoscopic techniques and robotic surgical systems have become a new trend in the development of surgical treatment. With the advantages of precision, minimally invasive and aesthetics, robotic surgery has been more and more widely used in the field of breast surgery. By analysing literature, this paper reviewed the application of robotic surgery in breast cancer treatment in recent years, including the development of the technology, feasibility and safety of the surgery, etc., so as to provide a theoretical basis for the application of robotic surgical systems in breast cancer treatment.

Key words: Breast cancer, Robotic surgical system, Mastectomy, Lymph nodes dissection

中图分类号:

R737.9

赵鑫, 高鹏, 陈洁. 机器人辅助手术系统在乳腺癌治疗中的应用及前景[J]. 外科理论与实践, 2024, 29(05): 376-381.

ZHAO Xin, GAO Peng, CHEN Jie. Robotic-assisted surgical systems in treatment of breast cancer: applications and prospects[J]. Journal of Surgery Concepts & Practice, 2024, 29(05): 376-381.

图/表 1

表1

来自Clinicaltrial.gov网站的有关机器人辅助乳腺手术的最新临床试验记录

Clinicaltrial.gov ID	研究单位	研究类型	研究对象	主要研究终点	状态	研究题目
NCT05945914	Chang Gung Memorial Hospital	前瞻性观察性研究	2020.3—2023.6同时接受机器人辅助乳房切除术和机器人辅助游离DIEP皮瓣采集术进行乳房重建的病人	急、慢性并发症发生率	已完成	Oncoplastic entirely robot-assisted approach (opera) - incorporating robotic surgery in both mastectomy and DIEP flap reconstruction
NCT04108117	Severance Hospital	多中心观察性研究	2016—2020年期间接受NSM的病人（共招募659例）	术后 30 d内的并发症发生率	已完成	Surgical and oncologic outcomes after RNSM and immediate reconstruction: an international multicenter pooled analysis
NCT06415526	Chang Gung Memorial Hospital	回顾性观察性研究	接受机器人辅助乳房切除术和机器人辅助游离 DIEP皮瓣采集术行乳房重建的单侧乳腺癌病人（共招募14例）	切口长度、手术时间、皮瓣大小	已完成	Oncoplastic entirely robot-assisted approach (OPERA) - incorporating robotic surgery in both mastectomy and DIEP flap reconstruction
NCT06532955	Maastricht University Medical Center	前瞻性干预性研究	60例接受机器人辅助或人工淋巴-静脉吻合术（LVA）治疗乳腺癌相关淋巴水肿（BCRL）的病人	LVA的效率	进行中	Pilot study on robotic assisted microsurgical lymphatico-venular anastomosis
NCT04585074	Severance Hospital	前瞻性观察性研究	19~80岁乳腺癌或乳腺癌高风险（BRCA1/2、TP53、PALB2基因突变等），计划接受治疗性或预防性乳房切除术，并希望即刻乳房重建的病人	术后30 d内并发症发生率、Clavien-Dindo术后并发症分级	进行中	Prospective cohort study of mastectomy with reconstruction including robot endoscopic breast surgery
NCT05720039	Intuitive Surgical (Responsible Party)	前瞻性、双臂、多中心、随机对照临床研究	≥21岁的早期乳腺癌病人，接受da Vinci机器人辅助SP手术或开放乳头乳晕切除术	da Vinci Xi机器人辅助手术转换为开放手术的比例、不良事件发生率、手术边缘阳性率	进行中	A prospective, multicenter randomized controlled trial (RCT) of the Da Vinci^® SP™ surgical system vs. open surgery in NSM procedures
NCT02274493	M.D. Anderson Cancer Center	前瞻性干预性临床研究	年满18岁且正在接受需采集背阔肌的整形手术，同意接受术后6个月的随访	机器人辅助采集术后背阔肌瓣（latissimus dorsi, LD）存活的参与者人数、术后 6个月捐献部位并发症评估	已完成	Pilot study of robotic-assisted harvest of the latissimus dorsi muscles
NCT03440398	European Institute of Oncology	前瞻性随机临床研究	82例接受开放NSM和即刻假体植入乳房重建术或RNSM的病人	病人的满意度；术后效果，包括并发症、术后疼痛、长期肿瘤治疗效果等	进行中	RNSM and immediate robotic breast reconstruction vs. conventional open technique: a prospective randomized trial evaluating patients satisfaction
NCT05490433	Yonsei University	前瞻性多中心随机临床研究	19~70岁确诊为乳腺癌，接受RNSM或传统开放NSM的病人	5年无病生存率、5年总生存率、5年乳腺癌特异性生存率	进行中	A Prospective Multicenter Rando-mized Clinical Trial: Robot-assisted vs. Open Nipple-sparing Mastectomy With Immediate Breast Reconstruction (ROM) Trial
NCT05448963	Chang Gung Memorial Hospita	前瞻性干预性临床研究	20~80岁乳腺癌病人或预防性乳房切除术候选者接受SP辅助单侧或双侧NSM	手术效果（使用da Vinci SP系统完成NSM，未转换为传统腹腔镜、多孔da Vinci手术或开放手术的比例）	进行中	A pilot study of RNSM followed by immediate breast reconstruction using da Vinci SP^® single-port system
NCT04151368	University Health Network, Toronto	前瞻性单臂干预性临床研究	患有浸润性乳腺癌、DCIS、BRCA或其他乳腺癌基因突变携带的任何年龄女性	RNSM可行性、切口并发症、首次复发部位	已暂停	Robotic NSM with immediate prosthetic breast reconstruction: prospective study of feasibility, safety and patient satisfaction, Toronto experience

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