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用于肝门部胆管癌的机器人泰姬陵式肝切除术

Robotic Taj Mahal Hepatectomy for Hilar Cholangiocarcinoma.

作者信息

Deng Zhaoda, Zhao Guodong, Wang Zizheng, Yu Linxiang, Zou Wenbo, Li Lincheng, Liu Rong

机构信息

Medicine school of Chinese PLA; Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center, Chinese PLA General Hospital.

Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center, Chinese PLA General Hospital.

出版信息

J Vis Exp. 2022 Jul 14(185). doi: 10.3791/63648.

Abstract

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In this study, a 32-year-old male patient with Bismuth Type IVa hilar cholangiocarcinoma underwent radical robotic resection of hepatic S4b, S5, and S1 (Taj Mahal hepatectomy) combined with regional lymphadenectomy, hilar bile duct reconstruction, and hepaticojejunostomy by the robotic surgical system. Postoperative pathological examination showed moderately-differentiated adenocarcinoma of the hilar bile duct. The surgical margins of the liver and bile ducts were negative. Recovery was smooth and the patient was discharged on the 17 postoperative day. The robotic surgical system and associated multiple instruments along with flexible and precise movements is suitable for the local hepatectomy around the porta hepatis, and delicate reconstruction of the hilar bile duct with a smaller diameter. This first clinical application study found that robotic Taj Mahal hepatectomy for hilar cholangiocarcinoma is safe and feasible and needs more experience for the evaluation of its long-term outcomes.

摘要

肝门部胆管癌是最常见的胆道恶性肿瘤。根治性手术切除是唯一有效的治疗选择。在本研究中,一名32岁的男性患者患有Bismuth IVa型肝门部胆管癌,接受了机器人辅助下肝S4b、S5和S1根治性切除术(泰姬陵肝切除术),并联合区域淋巴结清扫、肝门胆管重建以及机器人手术系统进行的肝空肠吻合术。术后病理检查显示肝门部胆管中分化腺癌。肝脏和胆管的手术切缘阴性。恢复顺利,患者术后第17天出院。机器人手术系统及相关多种器械配合灵活精确的操作,适用于肝门周围局部肝切除术以及直径较小的肝门胆管精细重建。这项首次临床应用研究发现,机器人辅助泰姬陵肝切除术治疗肝门部胆管癌安全可行,但评估其长期疗效还需要更多经验。

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