达芬奇机器人辅助单孔腹腔镜在子宫内膜癌全面分期术中的应用

Application of Da Vinci robot-assisted laparoendoscopic single-site in complete staging of endometrial cancer

摘要:

目的：探讨达芬奇机器人辅助单孔腹腔镜实施子宫内膜癌全面分期手术的可行性及安全性。方法：回顾性分析陆军军医大学第一附属医院妇科2019年2月至9月，采用达芬奇机器人手术系统辅助单孔腹腔镜下完成的9例早期子宫内膜癌全面分期手术临床资料。结果：9例子宫内膜癌手术方式均为筋膜外全子宫切除+双侧附件切除+Ⅱ级盆腔淋巴结切除术，手术均获成功。9例患者中，术前病理FIGO组织学分级 Ⅰ 级5例，Ⅱ 级4例；手术时间（251.67±78.32） min，术中出血量（261.11±92.80） mL，术后下床时间（16.00±2.66） h，尿管拔除时间（20.00±1.58） h，肛门排气时间（21.56±4.53） h，引流管拔除时间（27.22±17.87） h，术后住院时间（4.44±0.53） d。所有患者均未发生术中术后并发症，术后临床病理分期IA期8例，IB期1例（补充阴道近距离放疗）。术后1个月随访，阴道顶端无裂开，脐部切口愈合良好。结论：具备娴熟机器人手术技巧和单孔腹腔镜手术经验的主刀医生，实施达芬奇机器人手术系统辅助单孔腹腔镜子宫内膜癌全面分期手术安全可行。

Abstract:

Objective：To explore the safety and feasibility of Da Vinci robot-assisted laparoendoscopic single-site（LESS） in the com－plete staging of endometrial cancer. Methods：Clinical data of nine cases of early stage endometrial cancer complete staged surgery under the LESS assisted by Da Vinci robotic surgery system from February to September 2019 in the Department of Gynecology of The First Affiliated Hospital of Army Medical University were retrospectively analyzed. Results：Nine cases of endometrial cancer were treated with total fascial hysterectomy + bilateral appendectomy + class Ⅱ pelvic lymphadenectomy，and all operations were successful. Among the nine patients，five were grade Ⅰ and four were grade Ⅱ according to the histological grade of FIGO before surgery；the operation time was （251.67±78.32） min，the intraoperative blood loss was （261.11±92.80） mL，the time to get out of bed was （16.00±2.66） h，urinary tube removal time was （20.00±1.58） h，anal exhaust time was （21.56±4.53） h，drainage tube removal time was （27.22±17.87） h and postoperative hospital stay was （4.44±0.53） d. All patients had no intraoperative and postoperative complications. in Eight cases in IA staging and one case in IB stage（complementary brachytherapy） in postoperative clinicopathologi－cal staging. After follow-up of one month，no dehiscence at the upper end of vagina occurred and the umbilical incision recovered well. Conclusion：Physicians with experienced robotic surgery system and single-hole laparoscopic surgery can implement safely Da Vinci robotic surgery system to assist single-hole laparoscopic endometrial cancer in all stages.