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中华腔镜外科杂志(电子版) ›› 2022, Vol. 15 ›› Issue (02) : 110 -114. doi: 10.3877/cma.j.issn.1674-6899.2022.02.010

短篇论著

吲哚菁绿荧光实时导航达芬奇Xi机器人肝切除术初步探讨
李宁1, 杨真诚1, 李祥1, 苗心雨1, 陈雪健1, 王伟1, 徐力善1,()   
  1. 1. 150001 哈尔滨医科大学附属第四医院肿瘤外科肝胆外科
  • 收稿日期:2022-01-18 出版日期:2022-04-30
  • 通信作者: 徐力善
  • 基金资助:
    哈尔滨医科大学附属第四医院火炬计划(HYDSYHJ201903)

A preliminary study on real-time navigation of indocyanine green Xi da Vinci robot hepatectomy

Ning Li1, Zhencheng Yang1, Xiang Li1, Xinyu Miao1, Xuejian Chen1, Wei Wang1, Lishan Xu1,()   

  1. 1. Department of Hepatobiliary Surgery and Oncology Surgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • Received:2022-01-18 Published:2022-04-30
  • Corresponding author: Lishan Xu
引用本文:

李宁, 杨真诚, 李祥, 苗心雨, 陈雪健, 王伟, 徐力善. 吲哚菁绿荧光实时导航达芬奇Xi机器人肝切除术初步探讨[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(02): 110-114.

Ning Li, Zhencheng Yang, Xiang Li, Xinyu Miao, Xuejian Chen, Wei Wang, Lishan Xu. A preliminary study on real-time navigation of indocyanine green Xi da Vinci robot hepatectomy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(02): 110-114.

目的

总结达芬奇Xi机器人联合吲哚菁绿荧光定位肝脏肿瘤实现精准肝切除的经验。

方法

回顾分析2021年1~5月期间20例吲哚菁绿荧光定位联合达芬奇Xi机器人肝肿瘤切除术患者的临床资料。

结果

20例均在达芬奇Xi机器人下完成肝肿瘤切除,无中转开腹,手术时间85 min(70~105 min),术中出血量110 ml(50~200 ml ),术后住院时间7 d(5~9 d)。术后患者肝功能恢复良好,均未出现出血、胆漏等并发症。术后病理结果:肝细胞肝癌10例、肝细胞异型增生和胆管异形增生1例、胆管细胞癌6例、肝硬化伴肝脏炎性改变1例、腺癌(胃肠道转移)2例。20例均为R0切除,愈合良好出院。

结论

在熟练完成腹腔镜肝肿瘤切除术的基础上,开展吲哚菁绿荧光定位联合达芬奇Xi机器人手术系统精准肝切除是安全、可行的,具有较高的临床价值及推广意义。

Objective

To summarize the experience of precision liver resection by da Vinci Xi robot combined with indocyanine green fluorescence localization for liver tumor.

Methods

The clinical data of 20 patients with liver tumor resection by indocyanine green fluorescence localization combined with da Vinci Xi robot from Jan. to May 2021 were retrospectively analyzed.

Results

All 20 patients underwent liver tumor resection with the da Vinci Xi robot without intermediate open abdomen, with an operative time of 85 min(70-105 min), and intraoperative bleeding of 110 ml(50-200 ml). Postoperative hospital stay 7 d(5-9 d). The patients recovered well from postoperative liver function, and none of them had complications such as bleeding or bile leakage. The postoperative pathological results were: 10 cases of hepatocellular cancer, 1 case of hepatocellular heterogeneous hyperplasia and bile duct heterogeneous hyperplasia, 6 cases of bile duct cell carcinoma, 1 case of cirrhosis with inflammatory changes in the liver, and 2 cases of adenocarcinoma(gastrointestinal metastasis). 20 patients were resected with R0 and discharged with good healing.

Conclusions

Based on the skillful completion of laparoscopic liver tumor resection, it is safe and feasible to carry out accurate liver resection with indocyanine green fluorescence localization combined with da Vinci Xi robotic surgical system, which has high clinical value and promotion significance.

图1 两例肝肿瘤患者术前增强CT、增强核磁影像学资料注:A.增强CT动脉期;B.增强CT静脉期;C.增强CT平衡期;D.增强核磁动脉期;E.增强核磁静脉期;F.增强核磁平衡期
图2 肝肿瘤切除术布孔方式注:A.常规肝肿瘤切除术布孔方式;B.肝左外叶切除布孔方式
图3 6例肝肿瘤患者术中荧光显影和非荧光显影的对比注:A~J.术前48 h经肘正中静脉注射吲哚菁绿溶液;K、L.术中经外周静脉注射吲哚菁绿溶液
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