达芬奇机器人手术系统近端胃切除术中食管胃右开襟单肌瓣吻合的临床价值

Clinical value of right-sided overlap and single-flap valvuloplasty in Da Vinci robotic proximal gastrectomy

    摘要
  • 摘要:
    目的 探讨达芬奇机器人手术系统近端胃切除术中食管胃右开襟单肌瓣吻合的临床价值。
    方法 采用回顾性描述性研究方法。收集2023年9月到2024年5月徐州医科大学附属医院收治的12例行达芬奇机器人手术系统近端胃切除+食管胃右开襟单肌瓣吻合术患者的临床病理资料；男7例,女5例；年龄为62（35~75）岁。观察指标：（1）手术情况。（2）术后病理学检查结果。（3）随访情况。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（范围）表示；计数资料以绝对数表示。
    结果 （1）手术情况。所有患者顺利完成手术,无中转开腹。12例患者手术时间为（236±24）min,单肌瓣制作及吻合时间为（105±28）min,术中出血量为（36±19）mL,术后首次进食流质食物时间为（3.5±1.1）d,术后第1、2、3天腹腔引流管淀粉酶水平分别为（321±121）U/L、（225±97）U/L、（85±22）U/L,术后引流管拔除时间为（5.3±1.5）d,术后住院时间为（7.6±1.1）d。12例患者均无术后吻合口漏、吻合口出血、吻合口狭窄等吻合口相关并发症,无术后胃排空障碍、胃食管反流等功能性并发症。（2）术后病理学检查结果。12例患者肿瘤近端切缘距离为（1.8±1.1）cm,远端切缘距离为（5.7±2.1）cm,淋巴结清扫总数为31.0（22.0~45.0）枚,阳性淋巴结清扫数目为（3.4±2.4）枚,胰腺上缘淋巴结清扫数目为（14.7±4.3）枚。12例患者术后病理学检查结果显示：TNM分期Ⅰ期8例,Ⅱ期3例,Ⅲ期1例。（3）随访情况。12例患者均获得随访,随访时间为6（3~24）个月。随访期间,12例患者均无肿瘤局部复发和远处转移。12例患者均无吻合口漏、吻合口出血及吻合口狭窄等并发症,均未诉烧心、呕吐等胃食管反流症状。
    结论 达芬奇机器人手术系统近端胃切除术中采用食管胃右开襟单肌瓣吻合安全、可行。

     

    Abstract:
    Objective To investigate the clinical value of right-sided overlap and single-flap valvuloplasty (ROSF) in Da Vinci robotic proximal gastrectomy.
    Methods The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent ROSF in Da Vinci robotic proximal gastrectomy at The Affiliated Hospital of Xuzhou Medical University from September 2023 to May 2024 were collected. There were 7 males and 5 females, aged 62(range, 35‒75)years. Observation indicators: (1) surgical conditions; (2) postoperative pathological results; (3) follow-up. Measurement data with normal distribution were represented as Mean±SD, and mea-surement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers.
    Results (1) Surgical conditions. All patients successfully completed the surgery, without conversion to laparotomy. The operation time of 12 patients was (236±24)minutes. The time of single-layer fabrication and anastomosis was (105±28)minutes. The volume of intra-operative blood loss was (36±19)mL. Time to postoperative first fluid food intake was (3.5±1.1)days. The amylase levels in the abdominal drainage fluid on postoperative days 1, 2, and 3 were (321±121)U/L, (225±97)U/L, and (85±22)U/L, respectively. Time to postoperative drainage tube removal was (5.3±1.5)days. Duration of postoperative hospital stay was (7.6±1.1)days. All 12 patients had no anasto-motic related complications such as anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and had no functional complications such as gastric emptying disorders or gastroesophageal reflux after surgery. (2) Postoperative pathological results. The distance of the proximal tumor margin of the 12 patients was (1.8±1.1)cm. The distance of distal margin was (5.7±2.1)cm. Number of lymph node dissected was 31.0(range, 22.0‒45.0). Number of positive lymph node dissected was 3.4±2.4. Number of lymph node dissected from the pancreatic superior margin was 14.7±4.3. Results of postoperative pathological examination in the 12 patients showed 8 cases of Ⅰ stage, 3 cases of Ⅱ stage, 1 case of Ⅲ stage of the TNM staging. (3) Follow-up. All 12 patients were followed up for 6 (range, 3‒24)months. During the follow-up period, all 12 patients had no local tumor recurrence or distant metastasis. All 12 patients had no complications such as anastomotic leakage, anastomotic bleeding, or anastomotic stenosis, and did not experience symptoms of gastroesophageal reflux such as heartburn or vomiting.
    Conclusion The ROSF in Da Vinic robotic proximal gastrectomy is safe and feasible.

     

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