Kriger A G, Berelavichus S V, Smirnov A V, Gorin D S, Akhtanin E A
Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva.
Khirurgiia (Mosk). 2015(1):23-29. doi: 10.17116/hirurgia2015123-29.
It was performed a retrospective analysis of the results of distal pancreatic resections (DPR) in 89 patients with different tumors. Conventional open operations were performed in 60 patients, robot-assisted - in 19 patients, laparoscopic - in 10 cases. Absolute indication for open surgery was pancreatic cancer T3-4 stages. Mini-invasive distal resections (robot-assisted and laparoscopic) were performed in cases of pancreatic cancer T1-2 stages, benign tumors and tumors with low potential of malignancy and diameter up to 4-5 cm. Results of robot-assisted and laparoscopic interventions are similar but robot-assisted technique provides more precise surgery. It improves quality of lymphadenectomy, decreases probability of intraoperative bleeding. Duration of robot-assisted and open operation did not differ significantly. Blood loss was significantly lower in group of robot-assisted method (mean 470 ml) while in cases of open and laparoscopic techniques this parameter was 1013.8 and 833.3 ml respectively. Postoperative complications in open, laparoscopic and robot-assisted groups developed in 45.1, 52.6 and 50% of observations respectively. Pancreatic fistulas were revealed in 58.8, 80 and 58.3% of cases respectively. There were not deaths after laparoscopic and robot-assisted pancreatic resections. 2 patients died after open surgery.
对89例患有不同肿瘤的患者进行了远端胰腺切除术（DPR）结果的回顾性分析。60例患者进行了传统开放手术，19例患者进行了机器人辅助手术，10例患者进行了腹腔镜手术。开放手术的绝对指征是胰腺癌T3 - 4期。对于胰腺癌T1 - 2期、良性肿瘤以及恶性潜能低且直径达4 - 5 cm的肿瘤，进行了微创远端切除术（机器人辅助和腹腔镜手术）。机器人辅助手术和腹腔镜手术的结果相似，但机器人辅助技术提供了更精确的手术。它提高了淋巴结清扫的质量，降低了术中出血的概率。机器人辅助手术和开放手术的持续时间无显著差异。机器人辅助手术组的失血量显著更低（平均470 ml），而开放手术和腹腔镜手术组这一参数分别为1013.8 ml和833.3 ml。开放手术组、腹腔镜手术组和机器人辅助手术组的术后并发症分别在45.1%、52.6%和50%的观察病例中出现。胰瘘分别在58.8%、80%和58.3%的病例中出现。腹腔镜和机器人辅助胰腺切除术后无死亡病例。2例患者在开放手术后死亡。
