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中华腔镜外科杂志(电子版) ›› 2022, Vol. 15 ›› Issue (01) : 62 -64. doi: 10.3877/cma.j.issn.1674-6899.2022.01.014

病例报告

达芬奇机器人辅助保留脾脏的胰体、胰尾肿瘤切除术一例
王志伟1, 陈启阳1, 郭青松1, 黄1, 朱沙俊1, 陆玉华1,()   
  1. 1. 226001 南通大学附属医院肝胆胰腺外科
  • 收稿日期:2021-10-28 出版日期:2022-02-28
  • 通信作者: 陆玉华

Robotic spleen-preserving distal pancreatectomy: a case report and literature review

Zhiwei Wang1, Qiyang Chen1, Qingsong Guo1, Yan Huang1, Shajun Zhu1, Yuhua Lu1,()   

  1. 1. The Affiliated Hospital of Nantong University, Department of Pancreatic and Hepatobiliary Surgery, Nantong 226001, China
  • Received:2021-10-28 Published:2022-02-28
  • Corresponding author: Yuhua Lu
引用本文:

王志伟, 陈启阳, 郭青松, 黄, 朱沙俊, 陆玉华. 达芬奇机器人辅助保留脾脏的胰体、胰尾肿瘤切除术一例[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(01): 62-64.

Zhiwei Wang, Qiyang Chen, Qingsong Guo, Yan Huang, Shajun Zhu, Yuhua Lu. Robotic spleen-preserving distal pancreatectomy: a case report and literature review[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(01): 62-64.

目的

探讨达芬奇机器人辅助下保留脾脏的胰体、胰尾肿瘤切除术的临床疗效及优势。

方法

2020年5月,南通大学附属医院收治1例胰体、胰尾肿瘤患者,27岁,女性,MRI平扫+增强(上腹部)(1.5 T)检查提示:胰尾部占位,考虑神经内分泌肿瘤可能。在全身麻醉下使用达芬奇机器人(da Vinci Xi,P8)辅助保留脾脏的胰体、胰尾肿瘤切除术。术后评估患者的术中出血量、切口愈合、手术并发症、患者术后恢复及满意度情况。

结果

患者术中出血量少,术后恢复好,无腹腔出血、感染,脾脏顺利保留。术后随访1年,患者未出现手术并发症,患者满意度高。

结论

达芬奇机器人辅助保留脾脏的胰体、胰尾肿瘤切除术具有较传统腹腔镜手术更加高清的手术视野、安全且精准的手术操作,保留脾脏安全,可行度比传统腹腔镜手术更有优势。

Objective

To explore the feasibility and advantages of using robotic surgery system for spleen-preserving distal pancreatectomy.

Methods

A case of distal pancreatic tumor was admitted in May. 2020. A 27-year-old woman found a distal pancreatic tumor by the abdominal MRI. Consider the possibility of neuroendocrine tumors. Spleen-preserving distal pancreatectomy under general anesthesia assisted by da Vinci Xi(P8). The intraoperative bleeding, wound healing, surgical complications, patient recovery and patient satisfaction were evaluated.

Results

The patient had less intraoperative bleeding and recovered well postoperatively, without intra-abdominal bleeding, infection, and the spleen was smoothly preserved. At 1-year postoperative follow-up, no surgical complications occurred. The patient was satisfied with the surgery.

Conclusions

Robotic spleen-preserving distal pancreatectomy has a higher definition of surgical field, safe and precise surgical operation than conventional laparoscopy, spleen sparing is safe and feasible with more advantages than conventional laparoscopy.

图1 胰腺肿瘤患者的术前上腹部影像 注:胰腺肿瘤位于胰体、胰尾部(A、B)
图2 机器人辅助保留脾脏的胰体、胰尾肿瘤切除术 注:A.解剖并夹闭主胰管;B.游离脾静脉并离断胰尾静脉;C.解剖并夹闭胰横动脉;D.4-0 Prolone连续缝合胰腺残端,创面无出血和胰漏
图3 机器人辅助保留脾脏的胰体、胰尾肿瘤切除术后半年影像 注:脾动、静脉无狭窄,脾脏血供正常(A、B)
1
Raphael BJ, Hruban RH, Aguirre AJ, et al. Integrated genomic characterization of pancreatic ductal adenocarcinoma[J]. Cancer Cell, 201732(2):185-213.
2
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019[J]. CA Cancer J Clin Wiley, 201969:7-34.
3
Freddie, Bray, Jacques, 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, 2018,394-424.
4
Kaur S, Baine MJ, Jain M, et al. Early diagnosis of pancreatic cancer: challenges and new developments[J]. Biomarkers in Medicine, 20126(5):597-612.
5
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013[J]. CA Cancer J ClinAmerican Cancer Society, 201363:11-30.
6
杨春明.实用普通外科手术学[M].北京:人民卫生出版社,2014,842-889.
7
Cooperman AM, Hoerr SO. Surgery of the pancreas: a textand atlas[M]. CV Mosby: St Louis, 1978.
8
Warshaw AL. Conservation of the spleen with distal pancreatectomy[J]. Arch Surg, 1988123(5):550-553.
9
Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors[J]. Surgery, 1996120:1051-1054.
10
Kimura W, Inoue T, Futakawa N, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein[J]. Surgery, 1996120:885-890.
11
Benoist S, Dugué L, Sauvanet A, et al. Is there a role of preservation of the spleen in distal pancreatectomy[J]. J Am Coll Surg, 1999188:255-260.
12
Shoup M, Brennan MF, McWhite K, et al. The value of splenic preservation with distal pancreatectomy[J]. Arch Surg, 2002137:164-168.
13
Antoniou GA, Riga CV, Mayer EK, et al. Clinical applications of robotic technology in vascular and endovascular surgery[J]. J Vasc Surg, 201153(2):493-499.
14
Rubin LG, Schaffner W. Clinical practice. care of theasplenic patient[J]. New England Journal of Medicine, 2014371(4):349-356.
15
Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminaryresults of the MRC randomised controlled surgical trial[J]. The surgical cooperative group. Lancet, 1996347:995-999.
16
Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resectionsfor gastric cancer: long-term results of the MRC randomized surgical trial[J]. Surgical Co-operative Group. BrJ Cancer, 199979:1522-1530.
17
Griffith JP, Sue-Ling HM, Martin I, et al. Preservation of the spleen improvessurvival after radical surgery for gastric cancer[J]. Gut, 199536:684-690.
18
McGory ML, Zingmond DS, Sekeris E, et al. Thesignificance of inadvertent splenectomy during colorectalcancer resection[J]. Arch Surg, 2007142:668-674.
19
Jung M, Morel P, Buehler L, et al. Robotic general surgery: current practice,evidence, and perspective[J]. Langenbecks Arch Surg, 2015400(3):283-292.
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