[1]王晓鹏,郭进,李渊,等.达芬奇机器人联合淋巴示踪在进展期远端胃癌根治术中的应用[J].中国微创外科杂志,2018,18(3):225-229.
　Wang Xiaopeng,Guo Jin,Li Yuan,et al.Application of da Vinci Robot Combined With Lymphatic Tracer in Radical Gastrectomy for Advanced Gastric Cancer[J].Chinese Journal of Minimally Invasive Surgery,2018,18(3):225-229.
点击复制

达芬奇机器人联合淋巴示踪在进展期远端胃癌根治术中的应用()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年3期
页码:
225-229
栏目:
临床研究
出版日期:
2018-05-01

文章信息/Info

Title:
Application of da Vinci Robot Combined With Lymphatic Tracer in Radical Gastrectomy for Advanced Gastric Cancer
作者:
王晓鹏; 郭进; 李渊; 史浩车; 杨苏河**; 郭天康**
甘肃省人民医院普外临床中心，兰州730000
Author(s):
Wang Xiaopeng;  Guo Jin;  Li Yuan;  et al.
General Surgery Clinical Center, Gansu Provincial Hospital, Lanzhou 730000, China
关键词:
达芬奇机器人手术系统; 纳米碳; 胃癌根治术; 淋巴结
Keywords:
The da Vinci robot operating system; Carbon nanoparticle; Radical gastrectomy; Lymph node
文献标志码:
A
摘要:
目的探讨达芬奇机器人联合淋巴示踪技术在进展期远端胃癌根治术中的应用效果。方法回顾性分析2016年6月~2017年6月72例进展期远端胃癌患者临床资料，根据患者自身经济状况及自愿选择分为达芬奇+纳米碳组24例，开腹手术+纳米碳组20例，开腹手术组（无术中淋巴结示踪）28例。对3组淋巴结检出情况、术后资料进行比较。结果达芬奇+纳米碳组检出淋巴结（28.9±5.3）枚/例，明显高于开腹手术+纳米碳组（24.6±5.5）枚/例（P=0.006）及开腹手术组（20.2±4.5）枚/例（P=0.000）；达芬奇+纳米碳组检出淋巴结黑染率75.9%（527/694），黑染淋巴结的肿瘤阳性率为271%（143/527），与开腹手术+纳米碳组（27.0%，103/382）无统计学差异（χ2=0.003，P=0.954）。达芬奇+纳米碳组出血量（162.5±84.0）ml，明显少于开腹手术+纳米碳组（227.0±53.9）ml（P=0.005）和开腹手术组（208.9±76.0）ml（P=0026）；3组手术时间、术后吻合口或残端漏、术后出血、淋巴漏发生率无统计学差异（P>0.05）。达芬奇+纳米碳组术后排气时间（2.2±0.6）d，明显早于开腹手术+纳米碳组（3.7±1.3）d（P=0.000）和开腹手术组（4.0±1.2）d（P=0.000）。达芬奇+纳米碳组术后48 h疼痛评分（0.40±0.16）分，明显低于开腹手术+纳米碳组（1.33±0.18）分（P=0.000）和开腹手术组（1.36±0.20）分（P=0.000）。达芬奇+纳米碳组术后住院时间（9.5±3.5）d，明显短于开腹手术+纳米碳组（15.4±4.9）d（P=0.000）和开腹手术组（16.2±4.8）d（P=0.000）。开腹手术+纳米碳组术中严重副损伤发生率最高（P=0.015）。结论达芬奇联合纳米碳在进展期胃癌根治术淋巴结清扫中操作安全可行，创伤小，患者术后恢复快；在淋巴结清扫方面，纳米碳具有良好的淋巴结示踪效果，淋巴结检出数量明显提高。
Abstract:
ObjectiveTo investigate the clinical effect of carbon nanoparticle lymphatic tracer in da Vinci robotassisted radical gastrectomy for advanced gastric cancer.MethodsClinical data of 72 patients with advanced gastric cancer who were admitted to our hospital from June 2016 to June 2017 were analyzed retrospectively. They were divided into three groups by the patients’ wishes and their own economic situation: The robot with carbon nanoparticle group (n=24), the laparotomy with carbon nanoparticle group (n=20), and laparotomy group (n=28, without intraoperative lymph node tracing). Comparison of the results of harvested lymph nodes and the postoperative data were made.ResultsThe number of harvested lymph nodes in the robot with carbon nanoparticle group (28.9±5.3) was significantly higher than that in the laprascopy with carbon nanoparticle group (24.6±55, P=0.006) and laparotomy group (20.2±4.5, P=0.000). The rate of blackdyed harvested lymph node was 75.9% (527/694) and the metastasis rate of blackdyed lymph nodes was 27.1% (143/527) in the robot with carbon nanoparticle group, without significant difference compared to the laparotomy with carbon nanoparticle group ［27.0% (103/382), χ2=0.003, P=0954］. The bleeding volume of the robot with carbon nanoparticle group ［(162.5±84.0) ml］ was less than that of laparotomy with carbon nanoparticle group ［(2270±53.9) ml, P=0.005］ and laparotomy group ［(208.9±76.0) ml, P=0.026］. There was no statistical difference among the three groups in terms of operation time, postoperative anastomotic stoma or stump leakage, incidence of postoperative bleeding, and incidence of lymphatic leakage (P>0.05). The time to postoperative passage of gas in the robot with carbon nanoparticle group ［(22±0.6) d］ was significantly earlier than that in the laparotomy with carbon nanoparticle group ［(3.7±1.3) d, P=0.000］ and the laparotomy group ［(4.0±1.2) d, P=0.000］. The postoperative 48 h pain score in the robot with carbon nanoparticle group ［(0.40±0.16) points］ was significantly lower than that in the laparotomy with carbon nanoparticle group ［(1.33±0.18) points, P=0.000］ and the laparotomy group ［(1.36±0.20) points, P=0.000］. The average hospital stay after operation in the robot with carbon nanoparticle group ［(9.5±3.5) d］ was significantly less than the laparotomy with carbon nanoparticle group ［(15.4±4.9) d, P=0.000］ and the laparotomy group ［(16.2±4.8) d, P=0.000］. The incidence of severe secondary injuries was the highest in the laparotomy group, with the difference statistically significant (P=0.015).ConclusionsThe application of da Vinci combined with use of carbon nanoparticle in lymph node dissection for radical gastrectomy for advanced gastric cancer is safe and feasible. The patients have small trauma and quick recovery after surgery. For the lymph node dissection, use of carbon nanoparticles has good tracing effect and improves the number of lymph node detection.

参考文献/References:

[1]耿宏智,刘兵,徐艺可,等.影响进展期胃癌淋巴结转移率分期和转移数量分期的病理因素.中华胃肠外科杂志,2013,16(4):358-362.
[2]黎焕君,刘琦,陈志良,等.淋巴结转移率对胃癌D2根治术患者的预后分析.肿瘤学杂志,2016,22(4):300-304.
[3]陈鸿源,王亚楠,薛芳沁,等.腹腔镜下静脉输液针注射法纳米碳淋巴示踪技术在胃癌根治术中的应用.中华胃肠外科杂志,2014,17(5):457-460.
[4]Zhang J,Zhou Y,Jiang K, et al.Evaluation of the seventh AJCC TNM staging system for gastric cancer: a metaanalysis of cohort studies.Tumor Biol,2014,35(9):8525-8532.
[5]刘凤林,闾晨涛,秦净,等.达芬奇人工智能手术系统辅助胃癌手术.中华胃肠外科杂志,2010,13(5):327-329.
[6]胡祥.第14版日本《胃癌处理规约》的重要变更.中国实用外科杂志,2010,30(4):241-246.
[7]刘江文,孙琳,仝德峰,等.远端进展期胃癌腹腔镜辅助与开腹D2根治术淋巴结清扫的临床对照研究.中国微创外科杂志，2014,14(11):981-983,986.
[8]Yoshida K,Ohta K,Ohhashi I,et al.Studies on gastric lymphatics by using activated carbon particle (CH44) and lymph node metastasis of gastric cancer.Nihon Geka Gakkai Zasshi,1988,89(5):664-670.
[9]魏亚秋,樊勇,刘永永,等.纳米炭示踪技术在腹腔镜进展期胃癌根治术中的临床应用.中国微创外科杂志,2016,16(12):1113-1116.
[10]江志伟,赵坤,王刚,等.手术机器人系统在120例胃癌患者治疗中的应用.中华胃肠外科杂志,2012,15(8):801-803．
[11]苏向前,邢加迪.示踪技术在胃癌诊治中的应用.中国实用外科杂志,2005,25(7):392-394.

备注/Memo

备注/Memo:
基金项目：甘肃省人民医院科研基金（16GSSY2-5）**通讯作者，E-mail：suhe-1965@hotmail.com（苏河）；guotk-doc@163.com(郭天康)
更新日期/Last Update: 2018-05-10