探讨利用机器人手术系统的优势联合进行食管裂孔疝无张力修补与胰腺中段切除、端端吻合术的可行性。

优化胰腺中段切除的微创手术入路，利用机器人先行食管裂孔疝的疝内容物的松解复位、缩小裂孔、安放固定补片与胃底折叠术，随后继续进行胰腺中段切除，在近、远两端胰管内置入8号管后行胰腺端端吻合术。

避免二次手术与减少手术操作孔数，术后患者恢复良好。复查CT显示胃底复位良好，胰腺肿瘤已切除，胰腺端端吻合处对位良好、支架管在位；术后病理提示近、远端切缘净。

经文献检索，本病例报告是国内首例机器人经腹食管裂孔疝无张力修补、胃底折叠术联合胰腺中段切除、胰管成形、端端吻合术。本病例利用机器人联合手术治疗的成功有助于将来可能进行的多疾病联合手术治疗提供经验与思路。

To explore the feasibility of using the advantages of robotic surgical system to perform tension-free repair of esophageal hiatus hernia, central pancreatectomy and end-to-end anastomosis.

Minimally invasive surgical approach for the central pancreatectomy was optimized, and by robot the hiatus hernia contents were release and reset, the hiatus was narrowed, mesh was placed and fixed, and fundoplication was performed. Then we continued to excise the middle part of the pancreas, and put no. 8 tube into the proximal and distal pancreatic duct, and then performed end-to-end pancreatic anastomosis.

In addition to avoiding the patient′s second operation and reducing the number of operative holes, the patient recovered well after the operation. CT review showed that the gastric fundus was well repositioned, the pancreatic tumor had been removed, the end-to-end anastomosis of the pancreas was in good alignment, and the tube position was normal. Postoperative pathology revealed negative proximal and distal cutting margins.

The case report in this paper is the first in China to use robotic surgical system to perform transabdominal tension-free repair of esophageal hiatus hernia, fundoplication combined with central pancreatectomy, pancreatic duct formation, and end-to-end anastomosis. The success of treatment in this case is helpful to provide experience and ideas for future combined surgical treatment of multiple diseases.