本文選題：膽總管囊腫 + Roux-en-Y膽腸吻合術(shù)��； 參考：《上海交通大學(xué)》2015年碩士論文

【摘要】：目的:評(píng)價(jià)機(jī)器人輔助手術(shù)治療成人型膽總管囊腫的有效性、安全性及臨床療效,探討成人型膽總管囊腫機(jī)器人輔助手術(shù)治療的適應(yīng)癥及可能優(yōu)勢(shì),總結(jié)手術(shù)流程和操作技巧。方法:回顧分析2010~2014年間我院應(yīng)用da Vinci機(jī)器人手術(shù)系統(tǒng)為4例成人型膽總管囊腫患者行“膽總管囊腫切除+Roux-en-Y膽腸吻合術(shù)”手術(shù)治療的臨床資料,并與同期收治的12例成人型膽總管囊腫患者行開腹“膽總管囊腫切除+Roux-en-Y膽腸吻合術(shù)”手術(shù)治療資料進(jìn)行對(duì)比分析。通過分別記錄和對(duì)比各組臨床手術(shù)資料,初步評(píng)價(jià)機(jī)器人輔助手術(shù)系統(tǒng)在成人型膽總管囊腫治療方法上的可能的優(yōu)勢(shì),總結(jié)手術(shù)適應(yīng)證、手術(shù)操作過程和技巧。結(jié)果:兩組患者手術(shù)均獲成功,機(jī)器人輔助手術(shù)組無一例中轉(zhuǎn)開腹。機(jī)器人手術(shù)組手術(shù)時(shí)間90~170min,平均(127.5±35.0)min;術(shù)中出血量0~50ml,平均(25.0±28.9)ml,術(shù)中、術(shù)后均無輸血;術(shù)后住院天數(shù)8~16d,平均(11.8±3.9)d。開腹手術(shù)組手術(shù)時(shí)間150~250min,平均(195±33.9)min;術(shù)中出血量0~300ml,平均(179.2±91.6)ml,術(shù)中、術(shù)后均無輸血;術(shù)后住院天數(shù)9~24d,平均(13.8±4.4)d。機(jī)器人手術(shù)組手術(shù)時(shí)間及術(shù)中出血量均優(yōu)于開腹組(P0.05)。兩組患者隨訪5~31個(gè)月,均無復(fù)發(fā)及其他并發(fā)癥出現(xiàn)。結(jié)論:對(duì)于成人型膽總管囊腫患者,應(yīng)用機(jī)器人系統(tǒng)輔助行“膽總管囊腫切除+Roux-en-Y膽腸吻合術(shù)”安全、可行,手術(shù)創(chuàng)傷小,術(shù)后恢復(fù)快,為膽總管囊腫患者的手術(shù)治療提供了更多選擇。其優(yōu)勢(shì)有待進(jìn)一步增加病例數(shù)及遠(yuǎn)期隨訪結(jié)果證實(shí)。
[Abstract]:Objective: to evaluate the efficacy, safety and clinical efficacy of robot-assisted surgery in the treatment of adult choledochal cysts, to explore the indications and possible advantages of robot-assisted surgery for adult choledochal cysts, and to summarize the surgical procedures and techniques. Methods: the clinical data of 4 adult patients with choledochal cyst underwent choledochal cyst resection Roux-en-Y choledochojejunostomy with da Vinci robotic surgical system in our hospital from 2010 to 2014 were retrospectively analyzed. The operative data of 12 adult patients with choledochal cyst treated by open choledochal cyst resection Roux-en-Y choledochojejunostomy were compared and analyzed. By recording and comparing the clinical data of each group, the possible advantages of robot-assisted surgery system in the treatment of adult choledochal cyst were evaluated, and the indications, procedures and techniques of operation were summarized. Results: the operation was successful in both groups. In the robotic operation group, the operation time was 90 ~ 170 min (mean 127.5 鹵35.0 min), the blood loss was 0.50 ml (mean 25.0 鹵28.9 ml), no blood transfusion was found during the operation, and the hospital stay was 816 days, with an average of 11.8 鹵3.9 days. In the open operation group, the operation time was 150 ~ 250 min, the average time was 195 鹵33.9 min, the blood loss was 0.300 ml, the average was 179.2 鹵91.6 ml, there was no blood transfusion during the operation, and the hospital stay was 924 days, with an average of 13.8 鹵4.4 days. The time of operation and the amount of intraoperative bleeding in the robot operation group were better than that in the open operation group (P 0.05). The patients in both groups were followed up for 5 ~ 31 months. No recurrence or other complications occurred. Conclusion: for adult patients with choledochal cyst, "choledochal cyst resection by Roux-en-Y choledochojejunostomy" is safe, feasible, minimal trauma and quick recovery. It provides more options for surgical treatment of choledochal cyst patients. Its advantages need to be further increased in the number of cases and long-term follow-up results confirmed.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.4

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