摘要目的:探讨“N”字形Trocar布置法在达芬奇机器人手术系统减重代谢手术中的应用价值。方法:采用回顾性描述性研究方法。收集2020年3―10月吉林大学中日联谊医院收治的69例行达芬奇机器人手术系统减重代谢手术病人的临床资料；男18例，女51例；中位年龄为34岁，年龄范围为12~67岁。手术均采用“N”字形Trocar布置法，由同一手术团队施行。根据病人具体情况行达芬奇机器人手术系统袖状胃切除术（RSG）、达芬奇机器人手术系统袖状胃切除联合单吻合口十二指肠回盲旁路术（RSADI-S）或达芬奇机器人手术系统胆胰转流十二指肠转位术（RBPD-DS）。观察指标：（1）手术及术后情况。（2）随访情况。采用门诊、电话及微信等方式进行随访，了解病人术后3个月体质量、体质量指数、空腹血糖、糖化血红蛋白、总胆固醇、Trocar相关并发症。随访时间截至2020年11月。正态分布的计量资料以 x±s表示，病人手术前后一般情况比较采用配对 t检验。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）手术及术后情况：69例病人中，34例行RSG，34例行RSADI-S，1例行RBPD-DS；无中转开腹或中转腹腔镜手术。69例病人手术时间为（161±52）min，术中出血量为30 mL（10~100 mL）。69例病人中，2例发生术后并发症，其中1例为术后腹腔出血，对症治疗后于术后第10天痊愈出院；1例为术后腹腔积液，穿刺引流及对症治疗后痊愈出院。69例病人均无Trocar孔出血、Trocar孔疝等Trocar相关并发症发生，术后住院时间为（6±3）d。（2）随访情况：69例病人中，47例术后随访3个月，术后3个月体质量、体质量指数、空腹血糖、糖化血红蛋白、总胆固醇分别为（86±19）kg、（30±5）kg/m 2、（5.2±0.7）mmol/L、5.3%±0.6%、（4.3±1.3）mmol/L，上述指标与术前比较，差异均有统计学意义（ t=6.101，8.261，2.973，2.567，2.098， P<0.05）。随访期间47例病人均无Trocar相关并发症发生。 结论:“N”字形Trocar布置法应用于达芬奇机器人手术系统减重代谢手术安全、可行，疗效较好。

abstractsObjective:To investigate the application value of 'N' shaped Trocar placement in Da Vinci robotic bariatric and metabolic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of 69 patients who underwent Da Vinci robotic bariatric and metabolic surgery in the China-Japan Union Hospital of Jilin University from March to October 2020 were collected. There were 18 males and 51 females, aged from 12 to 67 years, with a median age of 34 years. The surgery was performed with the 'N' shaped Trocar placement by the same team of surgeons. The Da Vinci robotic sleeve gastrectomy, Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy or Da Vinci robotic biliopancreatic diversion with duodenal switch was selected according to the patient's condition. Observation indicators: (1) surgical and post-operative conditions; (2) follow-up. Follow-up using the outpatient examination, telephone interview and WeChat to detect the body weight, body mass index, fasting blood glucose, glycosylated hemoglobin, total cholesterol, Trocar-related complications of patients at postoperative 3 months. The follow-up was up to November 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison of general data before and after surgery was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions: of the 69 patients, 34 cases received Da Vinci robotic sleeve gastrectomy, 34 cases received Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy, and 1 case received Da Vinci robotic biliopancreatic diversion with duodenal switch. There was no conversion to open surgery or laparoscopic surgery. The operation time of 69 patients was (161±52)minutes, and the volume of intraoperative blood loss was 30 mL(range, 10-100 mL). Two of 69 patients had post-operative complications. One of them with postoperative abdominal hemorrhage was cured after symptomatic treatment and discharged on the 10th day after surgery. The other one patient with postoperative peritoneal effusion was cured and discharged from hospital after puncture drainage and symptomatic treatment. No Trocar-related complication such as Trocar foramen bleeding and Trocar foramen hernia occurred in the 69 patients. The duration of postoperative hospital stay of 69 patients was (6±3)days. (2) Follow-up: 47 of 69 patients were followed up for 3 months. The body mass, body mass index, fasting blood glucose, glycosylated hemoglobin, and total cholesterol were (86±19)kg, (30±5)kg/m 2, (5.2±0.7)mmol/L, 5.3%±0.6%, (4.3±1.3)mmol/L at postoperative 3 months, which had significant differences compared with the preoperative indicators ( t=6.101, 8.261, 2.973, 2.567, 2.098, P<0.05). All the 47 patients had no Trocar-related complications during the follow-up. Conclusion:The 'N' shaped Trocar placement method is safe and feasible in the Da Vinci robotic bariatric and metabolic surgery, with good efficacy.