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中华腔镜泌尿外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 96 -99. doi: 10.3877/cma.j.issn.1674-3253.2020.02.005

所属专题: 经典病例 机器人手术 经典病例 文献

临床研究

机器人辅助腹腔镜下腹膜后淋巴结清扫术六例报告
张尧1, 毕罡1, 张军1, 黄灶明1, 李珂1, 舒泽华1, 江军1,()   
  1. 1. 400042 重庆,陆军特色医学中心泌尿外科
  • 收稿日期:2018-12-04 出版日期:2020-04-01
  • 通信作者: 江军

Experiences of robot -assisted laparoscopic retroperitoneal lymph node dissection: 6 cases report

Yao Zhang1, Gang Bi1, Jun Zhang1, Zaoming Huang1, Ke Li1, Zehua Shu1, Jun Jiang1,()   

  1. 1. Department of Urology, Army Medical Center, Chongqing 400042, China
  • Received:2018-12-04 Published:2020-04-01
  • Corresponding author: Jun Jiang
  • About author:
    Corresponding author: Jiang Jun, Email:
引用本文:

张尧, 毕罡, 张军, 黄灶明, 李珂, 舒泽华, 江军. 机器人辅助腹腔镜下腹膜后淋巴结清扫术六例报告[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(02): 96-99.

Yao Zhang, Gang Bi, Jun Zhang, Zaoming Huang, Ke Li, Zehua Shu, Jun Jiang. Experiences of robot -assisted laparoscopic retroperitoneal lymph node dissection: 6 cases report[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(02): 96-99.

目的

总结6例机器人辅助腹腔镜下腹膜后淋巴结清扫术,对该手术的技巧方法和经验教训进行初步探讨。

方法

患者均为青年男性,睾丸胚胎癌根治术后,行机器人辅助腹腔镜下腹膜后淋巴结清扫术。手术体位采用健侧斜侧卧位+轻度折刀位,穿刺孔取脐旁为观察孔,常规取3个机器人操作手臂及2个助手孔,手术范围为标准清扫范围,清除所有患侧腹膜后淋巴组织。

结果

手术成功完成,术中出血100~250 ml,术后恢复良好。术后病理未发现淋巴结转移。

结论

机器人辅助腹腔镜下腹膜后淋巴结清扫术相对难度高,手术体位和穿刺孔的选择对手术成功与否至关重要,其精准和灵活的操作可以使患者明显受益,对交感干、腹主动脉及其分支、腔静脉及其分支的保护优于普通腹腔镜。

Objective

To summarize 6 cases of laparoscopic retroperitoneal lymph node dissection, and to explore the techniques and lessons of the operation.

Methods

All the patients were young men. After radical operation of testicular embryonic cancer, a robot-assisted laparoscopic hypogastric lymph node dissection was performed. The contralateral lateral decubitus position + mild jackknife position for surgery, observation hole located in the belly button, 3 robot operating arm and 2 assistant hole operation range for standard dissection, all retroperitoneal lymphes were removed.

Results

The operations were successfully completed, with about 100-250 ml of intraoperative blood loss. Patients recovered well after operation. Metastasis of tumor lymph nodes was not found by postoperative pathology.

Conclusion

Robotic-assisted laparoscopic retroperitoneal lymph node dissection is relatively difficult. The choice of surgical position and puncture hole is critical to the success of surgery. The precise and flexible operation of robot system can significantly benefit patients, and the protection of sympathetic trunk, abdominal aorta and its branches, vena cava and its branches is better than that of general laparoscopy.

图7 清扫过程中注意保护交感干(H为左侧交感干)
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