单一术者机器人辅助胰十二指肠切除术的近期疗效分析

Analysis of the short‑term outcomes of robot‑assisted pancreatoduodenectomy performed by one single surgeon

  • 摘要:
    目的 探讨单一术者机器人辅助胰十二指肠切除术(RPD)的近期疗效。
    方法 采用回顾性描述性研究方法。收集2016年7月至2023年10月中山大学附属第一医院收治的240例由单一术者行RPD患者的临床病理资料;男130例,女110例;年龄为59(19)岁。患者均由同一主刀医师行RPD。观察指标:(1)手术情况。(2)术后病理学检查及患者转归情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(IQR)表示。计数资料以绝对数或百分比表示。
    结果 (1)手术情况。240例患者中,15例联合血管切除重建,13例同期联合其他手术。240例患者中,4例中转开腹手术,中转开腹率为1.67%。240例患者手术时间为458(152)min,术中出血量为50(50)mL,17例患者术中输注红细胞,R0切除率为99.17%(238/240),淋巴结检出数目为10(6)枚,术后住院时间为17(12)d。(2)术后病理学检查及患者转归情况。240例患者中,胰腺导管腺癌51例、壶腹癌41例、神经内分泌肿瘤41例、胰腺囊性肿瘤35例、十二指肠癌28例、其他病理学类型44例。99例发生主要并发症患者中,临床相关术后胰瘘57例,术后胃排空延迟44例,术后胆瘘11例,术后乳糜漏8例,切口感染14例,术后出血24例(同一例患者可合并多种并发症)。240例患者中,6例术后再次手术,1例术后30 d内死亡。24例患者出院30 d内再返院。
    结论 单一术者RPD安全、可行,近期疗效良好,可在有成熟机器人辅助胰腺手术经验的中心开展。

     

    Abstract:
    Objective To investigate the short‑term outcomes of robot-assisted pancreato-duodenectomy (RPD) performed by one single surgeon.
    Methods The retrospective and descriptive study was conducted. The clinico-pathological data of 240 patients who were performed RPD by one single surgeon at The First Affiliated Hospital of Sun Yat‑sen University from July 2016 to October 2023 were collected. There were 130 males and 110 females, aged 59(19)years. All RPD were performed by the same surgeon. Observation indicators: (1) surgical situations; (2) postoperative pathological examination and outcome of patients. Measurement data with normal distribution were expressed as Mean±SD, and measurement data with skewed distribution were expressed as M(IQR). Count data were expressed as absolute numbers or percentages.
    Results (1) Surgical situations. Of 240 patients, 15 cases underwent combined vascular resection and reconstruction, and 13 patients were combined with other operations simultaneously. Of 240 patients, 4 cases converted to open surgery, with the conversion rate as 1.67%. The operation time of 240 patients was 458(152)minutes, volume of intraopera-tive blood loss was 50(50)mL, intraoperative erythrocyte transfusion was required in 17 patients. The R0 resection rate was 99.17%(238/240), the number of lymph nodes harvested was 10(6) and duration of postoperative hospital stay was 17(12)days. (2) Postoperative pathological examination and outcome of patients. Of 240 patients, 51 cases were pancreatic ductal adenocarcinoma, 41 cases were ampullary carcinoma, 41 cases were neuroendocrine neoplasms, 35 cases were pancreatic cystic neoplasms, 28 cases were duodenal carcinoma and 44 cases were other pathologic types. Of 99 patients with major complications, there were 57 cases with clinically relevant postoperative pancreatic fistula, 44 cases with postoperative delayed gastric empty, 11 cases with postoperative biliary fistula, 8 cases with postoperative chyle fistula, 14 cases with incision infec-tion, and 24 cases with postoperative hemorrhage. Multiple complications might occur to the same patient. Reoperation was performed in 6 of the 240 patients. One patient died within 30 days after surgery. Twenty-four patients returned to hospital within 30 days after discharge.
    Conclusions RPD performed by one single surgeon is safe and feasible, with favorable short‑term outcomes, which can be performed in medical centers with experiences in robot‑assisted pancreatic surgery.

     

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