中国普通外科杂志2024，Vol.33Issue(3)：349-356,8.DOI:10.7659/j.issn.1005-6947.2024.03.005
单中心学习曲线期机器人辅助胰腺手术50例临床分析
Clinical analysis of 50 cases of robot-assisted pancreatic surgery during learning curve period in a single center
摘要
Abstract
Background and Aims:Since the approval of the da Vinci robotic surgical system for clinical use in 2000,robot-assisted surgery has been widely adopted across various disciplines.Due to the complexity of pancreatic and periampullary anatomy,the application of robotic surgery systems in pancreatic surgery started later compared to other specialties.Although a few high-volume pancreatic surgery centers have accumulated experience with thousands of cases of robot-assisted pancreatic surgery(RPS),most units are still in the learning curve stage.This study was conducted to summarize the clinical efficacy and experience of RPS performed during the learning curve period in the authors'center,so as to provide reference information for clinical practice. Methods:The clinical data of 50 patients undergoing RPS in the First Affiliated Hospital of Nanchang University from January 2020 to September 2022 were retrospectively analyzed.Among them,there were 23 cases of pancreaticoduodenectomy,9 cases of tumor enucleation,8 cases of distal pancreatectomy with splenectomy,6 cases of central pancreatectomy,2 cases of duodenum-preserving pancreatic head resection,and 2 cases of spleen-preserving distal pancreatectomy.All surgeries were performed by the same team. Results:The mean operative time was(275±115)min,with(330±78)min for pancreaticoduodenectomy and(236±59)min for distal pancreatectomy with splenectomy.The average intraoperative blood loss was(315±259)mL.The incidence rates of overall complications and clinically relevant pancreatic fistula were 30.0%and 10.0%,respectively.The rate of Clavien-Dindo grade Ⅲ or above complications was 6.0%(3/50),with no deaths within postoperative 30 d,a conversion rate of 4%,and a reoperation rate of 2%.The mean length of postoperative hospital stay was(13.2±7.7)d.Among the malignant tumor patients(27 cases),the average number of lymph nodes retrieved was 14(4-34).The average follow-up period was(23.4±9.3)months,with two cases of pancreatic cancer recurrence at 12 and 14 months after operation,while the remaining patients showed no tumor recurrence. Conclusion:By rigorously adhering to surgical indications and drawing extensively from mature experiences,conducting RPS progressively advancing from simpler to more challenging cases during the learning curve period,is safe and feasible.关键词
胰腺切除术/机器人手术/学习曲线/安全Key words
Pancreatectomy/Robotic Surgical Procedures/Learning Curve/Safety分类
医药卫生引用本文复制引用
黄俊甫,辛万鹏,易思清,涂书举,熊远鹏,姜海,万真,肖卫东..单中心学习曲线期机器人辅助胰腺手术50例临床分析[J].中国普通外科杂志,2024,33(3):349-356,8.基金项目
江西省卫健委科技计划基金资助项目(202310238). （202310238）
