摘要目的 探讨达芬奇机器人手术系统辅助右半结肠癌根治术的临床疗效.方法 采用回顾性横断面研究方法.收集2013年8月至2019年2月陆军军医大学第一附属医院收治的85例右半结肠癌患者的临床病理资料;男56例,女29例;平均年龄为60岁,年龄范围为29～84岁.患者均行达芬奇机器人手术系统辅助右半结肠癌根治术,即右半结肠D3+全结肠系膜切除术.患者术后常规预防感染及全肠外营养支持治疗.术后1年内根据患者临床病理学分期[参照美国国立综合癌症网络(NCCN)结肠癌指南标准]行术后化疗.观察指标:(1)治疗情况.(2)术后病理学检查情况.(3)随访情况.采用门诊、电话和书信方式进行随访.术后1年内每3个月随访1次,术后1～3年每半年随访1次,术后3～5年每年随访1次,了解患者术后肿瘤转移和生存情况.随访时间截至2019年3月.正态分布的计量资料以Mean±SD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.采用寿命表法计算生存率.结果 (1)治疗情况:85例患者均行右半结肠D3+全结肠系膜切除术,顺利完成达芬奇机器人手术系统辅助右半结肠癌根治术.85例患者手术时间为(178±28) min,术中出血量为(85±33) mL,术后下床活动时间为(2.9±1.8)d,术后胃肠功能恢复时间为(3.1±2.7)d,术后进食流质食物时间为(3.9±1.9)d.85例患者无围术期死亡,其中11例术后发生并发症,吻合口漏5例,吻合口出血2例,肺部感染2例,胃排空障碍1例,不全性肠梗阻1例,均经保守治疗后治愈出院.85例患者术后均常规预防感染及全肠外营养支持治疗;其中64例行全身静脉化疗(方案为FOLFOX或XELOX),7例口服卡培他滨治疗(疗程均为6～8个周期),另14例术后未进行化疗.(2)术后病理学检查情况:85例患者淋巴结清扫数目为(20±11)枚,25例发生淋巴结转移;标本近端切缘长度和远端切缘长度分别为(16±5)cm和(9±5)cm,切缘残端病理学检查均未见癌细胞残留;肿瘤分化情况为高分化腺癌2例,中分化腺癌40例,中分化管状腺癌14例,低分化腺癌16例,黏液腺癌9例,管状腺癌并黏液腺癌4例;肿瘤TNM分期为Ⅰ期8例,ⅡA期28例,ⅡB期24例,ⅡC期5例,ⅢB期12例,ⅢC期8例.(3)随访情况:85例患者均获得术后随访,随访时间为1～ 67个月,中位随访时间为19个月.85例患者中,随访期间1例术后14个月发现肿瘤肝脏转移,行射频消融治疗后截至随访时间尚生存;3例因肿瘤腹腔转移死亡,其中1例ⅡC期术后32个月死亡,1例ⅢB期术后4个月死亡,1例ⅢB期术后16个月死亡.85例患者术后1、3年总体生存率分别为97.1％、94.0％.结论 达芬奇机器人手术系统辅助右半结肠癌根治术安全、可行,近、远期临床疗效良好.

abstractsObjective To investigate the clinical efficacy of Da Vinci robot-assisted radical resection for right colon cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 85 patients with right colon cancer who were admitted to the First Hospital Affiliated to Army Medical University from August 2013 to February 2019 were collected.There were 56 males and 29 females,aged from 29 to 84 years,with an average age of 60 years.All patients underwent Da Vinci robot-assisted radical resection of right colon cancer,named right hemicolon D3 + complete mesocolic excision,and received infection prevention and total parenteral nutrition treatment after surgery.According to clinical pathological staging of guideline issued by National Comprehensive Cancer Network,patients underwent postoperative chemotherapy within 1 year after surgery.Observation indicators:(1) treatment status;(2) postoperative pathological examination;(3) follow-up.Follow-up was conducted using outpatient examination,telephone interview and mail every 3 months within 1 year after surgery,every 6 months from 1 to 3 years after surgery,and once a year from 3 to 5 years after surgery up to March 2019.The postoperative tumor metastasis and survival of patients were obtained.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were expressed as absolute number.Survival rates were calculated using life-table method.Results (1) Treatment status:85 patients underwent Da Vinci robot-assisted right hemicolon D3 + complete mesocolic excision successfully.The operation time,volume of intraoperative blood loss,time for postoperative outof-bed activities,time to recovery of gastrointestinal function,time to liquid diet intake were (178±28) minutes,(85±33) mL,(2.9± 1.8) days,(3.1 ± 2.7) days,(3.9± 1.9) days,respectively.There was no perioperative death.Eleven patients had postoperative complications including 5 of anastomotic leakage,2 of anastomotic bleeding,2 of pulmonary infection,1 of gastric emptying disorder and 1 of incomplete intestinal obstruction;they were cured and discharged after conservative treatment.All the 85 patients received postoperative infection prevention and total parenteral nutrition support,including 64 receiving systemic intravenous chemotherapy with 6 -8 cycles of FOLFOX or XELOX,7 receiving 6-8 cycles of oral capecitabine,and 14 receiving no chemotherapy.(2) Postoperative pathological examination:the number of harvested lymph nodes was 20± 11 and 25 had lymph node metastasis.The length of proximal and distal cutting edge of the specimens was (16±5) cm and (9±5)cm,respectively.There was no cancerous cell on the cutting edge.High-differentiated adenocarcinoma,moderatedifferentiated adenocarcinoma,moderate-differentiated tubular adenocarcinoma,low-differentiated adenocarcinoma,mucinous adenocarcinoma,tubular combined with mucinous adenocarcinoma were detected in 2,40,14,16,9,4 patients,respectively.There were 8,28,24,5,12,8 patients in Ⅰ stage,Ⅱ A stage,Ⅱ B stage,Ⅱ C stage,ⅢB stage,Ⅲ C stage of TNM staging,respectively.(3) Follow-up:85 patients were followed up for 1-67 months,with a median follow-up time of 19 months.During the follow-up,1 of 85 patients had liver metastasis at 14 months after surgery and had survived after radiofrequency ablation treatment up to the end of follow-up.Three cases died of abdominal tumor metastases,1 of which in Ⅱ C stage died at 32 months after surgery,1 in Ⅲ B stage died at 4 months after surgery and 1 in Ⅲ B stage died at 16 months after surgery.The 1-,3-year overall survival rates were 97.1％ and 94.0％,respectively.Conclusion Da Vinci robot-assisted radical resection of right colon cancer is safe and feasible,with good short-and long-term outcomes.