机器人肝胆胰外科的创新与发展
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作者单位:

1.中国人民解放军总医院第一医学中心 肝胆胰外科医学部,北京 100853;2.中国人民解放军医学院,北京 100853;3.南开大学医学院,天津 300071

作者简介:

刘荣,中国人民解放军总医院第一医学中心肝胆胰外科医学部主任,全军肝胆外科研究所所长,南开大学医学院博士生导师。主要从事领域:肝癌与胰腺癌复发转移机制的基础研究;预后控制外科理论与技术方法的交叉学科研究;机器人与腹腔镜手术的外科临床研究;无线远程机器人(网络)手术的探索性研究。

基金项目:

科技创新2030-“新一代人工智能”重大基金资助项目(2021ZD0113301);北京市AI+健康协同创新培育课题基金资助项目(Z221100003522005)。


Innovation and development of robotic hepatobiliary and pancreatic surgery
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Affiliation:

1.Department of Hepatobiliary Pancreatic Surgery, First Medical Center, General Hospital of People's Liberation Army of China, Beijing 100853, China;2.Chinese People's Liberation Army Medical School, Beijing 100853, China;3.School of Medicine, Nankai University, Tianjin 300071, China

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    摘要:

    21世纪,外科学进入4.0时代,即外科学智能化时代。随着技术不断完善与发展,机器人手术已成为微创手术领域的重要发展方向。凭借高清三维立体视野,滤除手臂震颤等诸多显著技术优势,机器人手术在肝胆胰外科领域的应用日益广泛,并逐渐成为该领域主要手术方式。与传统开腹手术及腹腔镜手术相比,机器人肝胆胰手术在精确度和安全性方面展现出显著优势,不仅能减少患者术中出血量,还能缩短术后住院时间,加速患者康复。笔者所在中心是全球最大机器人肝胆胰外科手术中心之一,自2011年起,率先开展机器人肝胆胰手术,并成功实施近万例,积累了丰富的手术经验。在此期间,笔者团队建立了完整的机器人肝胆胰外科体系。本文汇总了目前国内外机器人肝胆胰外科领域的最新研究现状,结合笔者所在中心丰富临床经验,深入回顾机器人在胰腺外科、肝脏外科、胆道外科的研究进展与手术新技术,并对未来机器人肝胆胰外科发展趋势进行展望。

    Abstract:

    In the 21st century, surgery has entered the 4.0 era, also known as the era of surgical intelligence. As technology continues to improve and advance, robotic surgery has become an important direction of development in the field of minimally invasive surgery. With significant technical advantages such as high-definition 3D stereoscopic vision and the elimination of physiological tremors, robotic surgery is increasingly being applied in the field of hepatobiliary and pancreatic surgery, gradually becoming the primary surgical approach in this domain. Compared to traditional open surgery and laparoscopic surgical techniques, robotic hepatobiliary and pancreatic surgery demonstrates notable advantages in terms of precision and safety. It not only reduces intraoperative blood loss but also shortens postoperative hospitalization, thereby accelerating patient recovery. The authors' center is one of the largest robotic hepatobiliary and pancreatic surgery centers in the world. Since 2011, it has pioneered robotic hepatobiliary and pancreatic surgery and successfully performed nearly 10 000 cases, gaining a wealth of surgical experience. During this period, the authors' team established a complete robotic hepatobiliary and pancreatic surgery system. This article summarizes the latest research developments in the field of robotic hepatobiliary and pancreatic surgery at home and abroad, combining the rich clinical experience of the authors' center, to provide an in-depth review of the progress and and emerging surgical techniques in robotic pancreatic surgery, liver surgery, and biliary surgery, and also offer an outlook on future trends in robotic hepatobiliary and pancreatic surgery.

    图1 “L孔”“R孔”示意图[16] A:经“L孔”行胃肠吻合;B:经“R孔”行钩突游离、胆肠吻合Fig.1 Schematic diagram of L-port and R-port[16] A: Gastroenterostomy via the L-port approach; B: Uncinate process dissection or hepaticojejunostomy via the R-port approach
    图2 单针全层胰肠吻合(“301”胰肠吻合) A:置入与主胰管直径相匹配的硅胶管,缝合固定;B:缝合胰腺断端;C:缝合胰腺断端上端及空肠壁并打结;D:电凝钩于空肠侧壁相应位置开孔,置入胰管支撑管;E:行胰腺断端全层对空肠浆肌层自上而下连续缝合;F:收紧并打结固定Fig.2 Single-needle full-layer pancreaticojejunostomy (301-style pancreaticojejunostomy) A: Insertion of silicone tube matching the diameter of the main pancreatic duct and suture fixation; B: Suture the cut end of the pancreas; C: Suture the upper end of the pancreatic stump to the jejunal wall and tie the knot; D: Use an electrocautery hook to create an opening at the corresponding position on the jejunal side wall and insert the pancreatic duct stent; E: Full-thickness continuous suture of the pancreatic stump to the seromuscular layer of the jejunum from top to bottom; F: Tighten and tie the knot for fixation
    Fig.
    图3 1例肝癌患者术前及术中注射ICG后肝脏融合荧光显像[59] A:肿瘤区;B:瘤周区;C:缺血区;D:预留肝脏区Fig.3 Fused fluorescence imaging of the liver after preoperative and intraoperative injection of ICG in a patient with liver cancer[59] A: Tumor zone; B: Peritumoral zone; C: Ischemia zone; D: Reserved liver zone
    图4 全球首例多点协同5G远程多学科机器人手术试验Fig.4 The worlds first multi-point collaborative 5G remote multidisciplinary robotic surgery trial
    Fig.
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王冠宇,张修平,刘荣.机器人肝胆胰外科的创新与发展[J].中国普通外科杂志,2024,33(9):1357-1367.
DOI:10.7659/j. issn.1005-6947.2024.09.001

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  • 收稿日期:2024-09-04
  • 最后修改日期:2024-09-18
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  • 在线发布日期: 2024-10-12