腹部无辅助切口经阴道取标本的全机器人远端胃切除术(GC-NOSES Ⅳ式)

doi:10.3877/cma.j.issn.1674-6899.2021.01.011

目的

经自然腔道取标本手术(natural orifice specimen extraction surgery，NOSES)具有美观、腹壁损伤小、术后疼痛轻等优势，笔者旨在探究机器人(Da Vinci Xi)在胃癌NOSES中的手术技巧及应用要点。

方法

选取南昌大学第一附属医院普外科1例胃癌病例，简介使用Da Vinci Xi手术机器人系统进行腹部无辅助切口经阴道取标本的远端胃切除术的手术步骤。

结果

手术顺利完成，术中及术后无并发症。

结论

经腹部无辅助切口经阴道取标本的远端胃切除术是安全、可行的，机器人的应用为手术的进行创造了极大的便利。

关键词: 胃癌, 机器人手术, 经自然腔道取标本手术

Objective

The technology of natural orifice specimen extraction surgery (NOSES) has the advantages of beautiful appearance, less abdominal wall damage and less postoperative pain, etc. This article was aimed to explore the surgical skills and application points of Da Vinci Xi surgical robot system in NOSES for gastric cancer.

Methods

A case of gastric cancer in the Department of General Surgery of the First Affiliated Hospital of Nanchang University was selected to explain the operation steps of Da Vinci Xi surgical robot system for distal gastrectomy without auxiliary incision through vagina.

Results

The operation was completed successfully, no complications occurred during and after the operation.

Conclusions

Transvaginal natural orifice specimen extraction distal gastrectomy without an auxiliary incision is safe and feasible, and the application of robotic surgery system creates convenience for the operation.

Key words: Gastric cancer, Robotic surgery, Natural orifice specimen extraction

图1 机械臂安装(上腹)

图2 腹部Trocar布局

图3 机械臂安装(下腹)

图4 经阴道取标本

图5 手术标本

图6 标本切开

图7 腹部引流管放置

1	Bray Freddie, Ferlay Jacques, Torre Lindsey A, et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]．CA: A cancer journal for clinicians, 2018, 68(6): 394-424.
2	Hashizume M, Shimada M, Tomikawa M, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system[J]. Surgical Endoscopy & Other Interventional Techniques, 2002, 16(8): 1187-1191.
3	Kim KM, An JY, Kim HI, et al. Major early complications following open, laparoscopic and robotic gastrectomy[J]. British Journal of Surgery, 2012, 99(12): 1681-1687.
4	Zhou J, Shi Y, Tang B, et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes[J]. Surgical Endoscopy, 2014, 28(6): 1779-1787.
5	Haverkamp L, Ruurda JP, Offerhaus GJA, et al. Laparoscopic gastrectomy in western european patients with advanced gastric cancer[J]. European Journal of Surgical Oncology (EJSO), 2016, 42(1): 110-115.
6	Kim HI, Han SU, Yang HK, et al. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma[J]. Annals of Surgery, 2016, 263(1): 103-109.
7	Zhang Shu, Jiang Zhi-Wei, Wang Gang, et al. Robotic gastrectomy with transvaginal specimen extraction for female gastric cancer patients[J] .World J Gastroenterol, 2015, 47(21): 142-148.
8	中国经自然腔道取标本手术联盟．胃癌经自然腔道取标本手术专家共识(2019版)[J]．中华胃肠外科杂志，2019，22(8)：711-714.
9	Taiyuan Li, Jianping Gong, Jinzhong Duanmu, et al.Improved Iaparoscopic transanal pull-through technique for low-rectal cancer resection[J]. Chinese-German Journal of Clinical Oncology, 2010, 9(10): 606-609.
10	Hu WG, Ma JJ, Zang L, et al. Learning curve and long-term outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer[J]. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 2014, 24(7): 487-492.
11	Kang BH, Yi X, Hur H, et al. Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: the learning curve of robotic surgery[J]. Journal of Gastric Cancer, 2012, 12(3): 156-163.
12	汤庆超，陈瑛罡，王锡山，等. 腹部无切口经阴道拉出切除标本的腹腔镜中位直肠癌根治术[J]. 中华胃肠外科杂志，2014, (12): 1233-1235.
13	谭华勇，潘凯，钟克力，等．腹腔镜直肠癌根治术标本取出方法对肛门功能影响的研究 [J/CD]. 中华腔镜外科杂志(电子版), 2012, 5(6): 446-450.
14	赵恩生，汤小龙，曲辉，等. 完全腹腔镜下经阴道取标本的胃癌根治术1例报告[J]. 腹腔镜外科杂志，2019, 24(1)：71-72.
15	刘金超，于刚，荣震. 经自然腔道取出标本的全腹腔镜远端胃癌根治术(Uncut Roux-en-Y吻合)七例报告[J/CD]. 中华结直肠疾病电子杂志，2018, 7(4)：381-384.
16	王松，于刚，赵旭，等. 腹部无辅助切口经阴道取标本的全腹腔镜全胃切除术(GC-NOSES Ⅷ式) (附视频)[J/CD]. 中华结直肠疾病电子杂志，2020, 9(1)：96-100.
17	余佩武，陈凛，曹晖，等. 机器人胃癌手术专家共识(2015版)[J]. 中国研究型医院，2016, 3(1)：22-28.

[1]	关赛楠, 周希, 菅翠玲, 陈伟强, 傅绢, 宋长琳, 袁帆, 许尔蛟. 胃壁厚度在超声筛查胃部病变中的价值[J]. 中华医学超声杂志（电子版）, 2021, 18(08): 782-787.
[2]	张丹妮, 沈理, 张俊, 倪艳. 胃超声检查对胃癌诊断价值的Meta分析[J]. 中华医学超声杂志（电子版）, 2021, 18(04): 344-354.
[3]	翟育豪, 郑智, 邓薇, 白志刚, 尹杰, 张军. 进展期胃癌新辅助化疗争议的研究进展[J]. 中华普通外科学文献(电子版), 2021, 15(05): 386-390.
[4]	廖国庆, 何茂梁, 随凯, 张骏, 袁波, 何利, 曾昊, 程思俊, 欧梦川, 王思迅, 卢建利. 腹腔镜辅助远端胃癌根治术改良Uncut Roux-en-Y吻合对患者预后的影响[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 411-414.
[5]	代佑果, 苏有橦, 王嘉鑫, 胡义波, 吕煜, 韩潇, 陈林波. 单孔加一孔全腹腔镜远端胃癌根治术治疗Ⅰ期胃窦癌[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 237-238.
[6]	胡鹏, 梁文全, 张珂诚, 郗洪庆, 崔建新, 陈凛. 腹腔镜辅助和全腹腔镜远端胃癌根治术的短期疗效和生活质量的对比研究[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 141-148.
[7]	潘立超, 尹注增, 赵之明. 吲哚菁绿荧光显像在肝胆胰机器人手术中的应用实践与教学[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 149-151.
[8]	胡志豪, 李瑞欣, 王国俊. 食管胃结合部腺癌的微创外科治疗现状与展望[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 181-186.
[9]	赵国栋, 张新宁, 张修平, 赵之明, 高元兴, 刘渠, 王子政, 周志鹏, 刘荣. 分支胰管型导管内乳头状黏液腺瘤外科手术新策略：原位切除联合分支胰管齐根结扎术[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 109-111.
[10]	朱中飞, 何天霖. 达芬奇机器人脾动脉瘤切除重建一例[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 112-115.
[11]	谭志慧, 郑倩, 李爱娟, 彭艳. LncRNA MIR4435-2HG调控miR-138-5p/HMGA1轴对胃癌细胞的增殖、侵袭和迁移的影响[J]. 中华细胞与干细胞杂志(电子版), 2021, 11(03): 161-170.
[12]	汤庆超, 王锡山. 浅谈应用达芬奇机器人手术平台开展直肠癌NOSES手术的优越性和局限性[J]. 中华结直肠疾病电子杂志, 2021, 10(04): 343-350.
[13]	刘孟承, 黄贲, 任志鹏, 冷株赟, 高玮, 朱哲, 韩俊毅, 周主青, 傅传刚. 超重直肠癌患者NOSES手术可行性的影响因素分析[J]. 中华结直肠疾病电子杂志, 2021, 10(03): 243-249.
[14]	姜琪琪, 丰义宽, 张凯, 李倩, 季万胜. Δ133p53在rmhTNF干预人胃癌细胞MKN-45移植瘤生长中的作用[J]. 中华消化病与影像杂志(电子版), 2021, 11(05): 215-219.
[15]	李宝, 柴宁莉, 令狐恩强. 早期胃癌内镜下切除术后的复发及治疗现状[J]. 中华胃肠内镜电子杂志, 2021, 08(03): 119-124.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Transvaginal natural orifice specimen extraction robotic total distal gastrectomy without an auxiliary abdominal incision

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Transvaginal natural orifice specimen extraction robotic total distal gastrectomy without an auxiliary abdominal incision