探讨联合血管切除重建的机器人肝胆胰手术的安全性及临床疗效。

回顾性分析2016年1月至2019年10月解放军总医院第一医学中心肝胆外二科完成的14例联合血管切除重建的机器人肝胆胰手术患者的临床资料。

14例手术均在机器人下顺利完成，无中转开腹，重建血管术后早期无血栓性闭塞。14例手术中联合门静脉部分切除重建10例，其中2例使用了人造血管，联合动脉部分切除重建3例，联合肝中静脉部分切除重建1例。平均手术时间(294.9±80.7)min，术中中位出血量为150 ml，术后平均住院时间(12.0±5.1)d，围手术期死亡为0。14例中13例(92.9%)达到R0切除。截至2020年1月，1例胰腺实性假乳头状瘤随访3年无复发；13例恶性肿瘤平均随访15.5个月，其中3例胰腺癌因复发死亡，中位生存期为14个月；1例肝门部胆管癌术后26个月因复发死亡，其余9例存活患者仍在随访中。

机器人手术系统下联合血管切除重建是安全可行的，其肿瘤学优势尚需进一步评价。

To explore the safety and clinical effect of the robotic hepatobiliary and pancreatic surgery combined with vascular resection and reconstruction.

From Jan. 2016 to Oct. 2019, the clinical data of 14 cases of robotic hepatobiliary and pancreatic surgery with vascular resection and reconstruction completed in the second department of hepatobiliary surgery of the First Medical Center of PLA General Hospital were analyzed retrospectively.

All the 14 operations were successfully completed under the daVinci robotic system, without conversion to laparotomy, and without thromboembolism occlusion in the early stage after revascularization. 10 cases were reconstructed by combined partial portal vein resection, of which 2 cases were used artificial blood vessels, 3 cases were combined with partial artery resection and reconstruction, and 1 case was combined with partial middle hepatic vein resection and reconstruction. The average operation time was (294.9 ± 80.7) min, intraoperative bleeding volume was 150 ml, postoperative average hospital stay was (12.0 ± 5.1) days, and perioperative death was 0. Among the 14 cases, 13 achieved R0 resection (92.9%). As of Jan. 2020, 1 case of solid pseudopapilloma of the pancreas has been followed up for 3 years without recurrence, and 13 cases of malignant tumors have been followed up for an average of 15.5 months. Among them, 3 cases of pancreatic cancer died due to recurrence, with a median survival period of 14 months. One case of hilar cholangiocarcinoma died due to recurrence 26 months after operation, and the remaining 9 surviving patients are still in the follow-up.

The combination of vascular resection and reconstruction under the daVinci robotic system is safe and feasible, and its oncology advantages need to be further evaluated.