目的 探讨联合血管切除重建的机器人胰腺手术在局部进展期胰腺癌治疗中的可行性、安全性。方法 回顾性分析我院外科自2011年8月至2017年9月期间完成的联合血管切除重建的胰腺癌根治术59例病人的临床资料,根据手术方式分为机器人组（n=20）和开腹组（n=39）。其中,53例病理诊断为胰腺导管腺癌,6例为胰腺导管内乳头状黏液瘤癌变。均为局部进展期,Ⅱ期53例,Ⅲ期6例。对比分析两组病人术中与术后恢复情况。结果 机器人组手术时间为（328.9±17.8） min。术中估计出血量（568.4±72.6） mL。术后并发B/C级胰漏4例,胆漏1例,术后出血4例,3例接受再次手术。术后住院时间为（28.8±5.7） d。开腹组手术时间为（358.5±17.2） min。术中估计出血量（801.3±113.2） mL。术后并发B/C级胰漏12例,胆漏5例,术后出血4例,3例接受再次手术。术后住院时间为（31.3±5.1） d。两组病人手术治疗后均痊愈出院,无死亡病例。机器人组术中估计出血量较少（P=0.032）,术后住院时间较短（P=0.011）,差异具有统计学意义。结论 联合血管切除重建的机器人胰腺手术是安全可行的。
赵舒霖, 沈柏用, 邓侠兴, 詹茜, 王伟, 施源, 翁原驰, 孙长杰, 彭承宏
. 联合血管切除重建的机器人胰腺切除术治疗局部进展期胰腺癌[J]. 外科理论与实践, 2018
, 23(04)
: 352
-357
.
DOI: 10.16139/j.1007-9610.2018.04.016
Objective To examine feasibility and safety of robotic pancreatectomy with vascular resection and reconstruction in patients with locally advanced pancreatic cancer. Methods The authors evaluated 59 patients who underwent pancreatectomy with vascular resection and reconstruction from August 2011 to September 2017 dividing into robotic pancreatic surgery group (n=20) and open pancreatic surgery group (n=39) retrospectively. Pancreatic ductal adenocarcinoma was diagnosed 53 cases pathologically and intraductal papillary mucinous cancer 6 cases. The patients were all locally advanced pancreatic cancer including 53 cases in stage Ⅱ and 6 cases in stage Ⅲ. Intraoperative data and postoperative recovery in two groups were compared. Results Mean operative time in robotic pancreatic surgery group was (328.9±17.8) min. Mean blood loss was(568.4±72.6) mL. Grade B/C pancreatic fistula was found in 4 cases, biliary leak in 1 case and postoperative hemorrhage in 4 cases of whom 3 cases were re-operated. Mean postoperative hospital stay was (28.8±5.7) d. Mean operating time in open pancreatic surgery group was(358.5±17.2) min. Mean blood loss was (801.3±113.2) mL. Grade B/C pancreatic fistula was found in 12 cases, biliary leak in 5 cases and postoperative hemorrhage in 4 cases of whom 3 cases were re-operated. Mean postoperative hospital stay was (31.3±5.1) d. The patients of two groups were all recovered after postoperative treatment and discharged without mortalily. The mean blood loss was less （P=0.032） and the postoperative hospital stay was shorter （P=0.011）in robotic pancreatic surgery group when compared those in open pancreatic surgery group, respectively. Conclusions Robotic pancreatectomy with vascular resection and reconstruction was safe and feasible.
[1] 陈万青, 李贺, 孙可欣, 等. 2014年中国恶性肿瘤发病和死亡分析[J]. 中华肿瘤杂志,2018,40(1):5-13.
[2] Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11[EB/OL]. Lyon, France: International Agency for Research on Cancer,2013.[2018-3-9]. http://globocan.iarc.fr.
[3] Loveček M, Skalicky P, Klos D, et al.Surgical therapy of pancreatic cancer-5 years survival[J]. Rozhl Chir,2015, 94(11):470-476.
[4] Yamamoto T, Yagi S, Kinoshita H, et al.Long-term survival after resection of pancreatic cancer: a single-center retrospective analysis[J]. World J Gastroenterol,2015,21(1):262-268.
[5] Miyazaki M, Yoshitomi H, Shimizu H, et al.Repeat pancreatectomy for pancreatic ductal cancer recurrence in the remnant pancreas after initial pancreatectomy: is it worthwhile?[J]. Surgery,2014,155(1):58-66.
[6] Bockhorn M, Uzunoglu FG, Adham M, et al.Borderline resectable pancreaticcancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery,2014,155(6):977-988.
[7] Giulianotti PC, Addeo P, Buchs NC, et al.Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors[J]. Pancreas,2011,40(8):1264-1270.
[8] Bassi C, Marchegiani G, Dervenis C, et al.The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after[J]. Surgery,2017,161(3):584-591.
[9] Moore GE, Sako Y, Thomas LB.Radical pancreatoduodenectomy with resection and reanastomosis of the su-perior mesenteric vein[J]. Surgery,1951,30(3):550-553.
[10] Palanivelu C, Rajan PS, Rangarajan M, et al.Evolution in techniques of laparoscopic pancreaticoduodenectomy: A decade long experience from a tertiary center[J]. J Hepatobiliary Pancreat Surg,2009,16(6):731-740
[11] Kendrick ML, Cusati D.Total laparoscopic pancreaticoduodenectomy: Feasibility and outcome in an early experience[J]. Arch Surg,2010,145(1):19-23.
[12] Aosasa S, Nishikawa M, Noro T, et al.Total pancreatectomy with celiac axis resection and hepatic artery restoration using splenic artery autograft interposition[J]. J Gastrointest Surg,2016,20(3):644-647.
[13] Giulianotti PC, Sbrana F, Bianco FM, et al.Robot-assis-ted laparoscopic pancreatic surgery: single-surgeon experience[J]. Surg Endosc,2010,24(7):1646-1657.
[14] Kauffmann EF, Napoli N, Menonna F, et al.Robotic pancreatoduodenectomy with vascular resection[J]. Langenbecks Arch Surg,2016,401(8):1111-1122.
