达芬奇机器人辅助保留脾脏的胰体、胰尾肿瘤切除术一例

doi:10.3877/cma.j.issn.1674-6899.2022.01.014

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。

关键词: 机器人, 腹腔镜, 胰体、胰尾肿瘤, 保留脾脏

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.

Key words: Robotic surgery, Laparoscopic, Distal pancreatectomy, Splenic preservation

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)

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

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