机器人解剖性右肝后叶切除术

doi:10.3877/cma.j.issn.1674-6899.2023.01.014

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (01): 56 -59. doi: 10.3877/cma.j.issn.1674-6899.2023.01.014

病例报告

机器人解剖性右肝后叶切除术

周鹏宇¹, 涂志坚¹, 李传富¹, 雷晓华¹, 陈国栋¹^,^†(

)

^1. 421001　衡阳，南华大学附属第一医院肝胆胰外科

收稿日期:2023-01-01 出版日期:2023-02-28
通信作者: 陈国栋
基金资助:
湖南省自然科学基金（科卫联合项目）(2021JJ70039); 湖南省临床医疗技术创新引导项目(2020SK51817); 湖南省卫生健康委员会科技计划项目(20201064，20201919); 湖南省教育厅重点科研项目(21A0258); 南华大学医学临床研究"4310"计划培育项目(20224310NHYCG01)

Robotic anatomical right posterior hepatic lobectomy

Pengyu Zhou¹, Zhijian Tu¹, Chuanfu Li¹, Xiaohua Lei¹, Guodong Chen¹^,^†()

^1. The First Affiliated Hospital of University of South China, Department of Hepatopancreatobiliary Surgery, Hengyang 421001, China

Received:2023-01-01 Published:2023-02-28
Corresponding author: Guodong Chen

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目的

探讨应用达芬奇机器人行解剖性右肝后叶切除术的可行性、安全性及优势。

方法

选取南华大学附属第一医院于2020年12月收治的1例61岁男性肝肿瘤患者，腹部增强CT及MRI提示肝S6、S7段肝细胞癌可能，肿瘤大小约80 mm×60 mm。评估无明显手术禁忌证后，经充分术前准备，拟在全身麻醉下行机器人解剖性右肝后叶切除术，围手术期实施加速康复外科管理模式。

结果

手术顺利，手术时间约150 min，术中出血量约100 mL，术后无肝衰竭、出血、感染等并发症，术后7 d出院。术后病理示肝细胞癌，切缘均为阴性，术后4个月和10个月复查CT未见肿瘤复发、转移征象。

结论

机器人行解剖性右肝后叶切除术是安全、可行的。

关键词: 肝细胞癌, 机器人, 解剖性右肝后叶切除术

Objective

To explore the feasibility, safety and advantage of using da Vinci robot for anatomic right posterior hepatic lobectomy.

Methods

A case of focal liver lesions admitted to the First Affiliated Hospital of University of South China in Dec. 2020 was selected. A 61-year-old male found a hepatocellular carcinoma by the enhanced abdominal CT, located in S6 and S7 segments, and the size was about 80 mm×60 mm. Robot anatomical right posterior hepatic lobectomy was performed under general anesthesia, and ERAS management mode was applied in perioperative period.

Results

The operation was successful, the operation time was about 150 min, and the intraoperative blood loss was about 100 mL. There were no postoperative complications such as liver failure, bleeding and infection. The patient was discharged on the 7 days after operation. Postoperative pathology showed that the incisal margin was negative, and there were no signs of tumor recurrence and metastasis in CT at 4 and 10 months after operation.

Conclusions

Robot right posterior hepatic lobectomy is safe and feasible.

Key words: Hepatocellular carcinoma, Robot, Anatomical right posterior hepatic lobectomy

图1 术前MRI结果

图2 术前三维重建结果

图3 自制橡皮圈悬吊肝脏

图4 解剖并离断门静脉右后支

图5 显露并离断右肝后胆管

图6 切除后术区展示

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