机器人辅助微创全胰腺切除术联合胰岛自体移植治疗慢性胰腺炎。
Minimally invasive total pancreatectomy with islet autotransplantation for chronic pancreatitis: the robotic approach.
机构信息
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 665, Baltimore, MD, 21287, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Surg Endosc. 2024 Jul;38(7):3948-3956. doi: 10.1007/s00464-024-10904-w. Epub 2024 Jun 6.
INTRODUCTION
Total pancreatectomy with islet autotransplantation (TPIAT) treats refractory pain in chronic pancreatitis, prevents episodes of acute exacerbation, and mitigates postoperative brittle diabetes. The minimally invasive (MIS) approach offers a decreased surgical access trauma and enhanced recovery. Having established a laparoscopic TPIAT program, we adopted a robotic approach (R-TPIAT) and studied patient outcomes compared to open TPIAT.
METHODS
Between 2013 and 2021, 61 adult patients underwent TPIAT after a comprehensive evaluation (97% chronic pancreatitis). Pancreatic islets were isolated on-site during the procedure. We analyzed and compared intraoperative surgical and islet characteristics, postoperative morbidity and mortality, and 1-year glycemic outcomes.
RESULTS
MIS-TPIAT was performed in 41 patients (67%, 15 robotic and 26 laparoscopic), and was associated with a shorter mean length of intensive care unit stay compared to open TPIAT (2.9 vs 4.5 days, p = 0.002). R-TPIAT replaced laparoscopic TPIAT in 2017 as the MIS approach of choice and demonstrated decreased blood loss compared to open TPIAT (324 vs 843 mL, p = 0.004), similar operative time (609 vs 562 min), 30-day readmission rate (7% vs 15%), and 90-day complication rate (13% vs 20%). The glycemic outcomes including C-peptide detection at 1-year (73% vs 88%) and insulin dependence at 1-year (75% vs 92%) did not differ. The mean length of hospital stay after R-TPIAT was 8.6 days, shorter than for laparoscopic (11.5 days, p = 0.031) and open TPIAT (12.6 days, p = 0.017). Both MIS approaches had a 1-year mortality rate of 0%.
CONCLUSIONS
R-TPIAT was associated with a 33% reduction in length of hospital stay (4-day benefit) compared to open TPIAT. R-TPIAT was similar to open TPIAT on measures of feasibility, safety, pain control, and 1-year glycemic outcomes. Our data suggest that robotic technology, a new component in the multidisciplinary therapy of TPIAT, is poised to develop into the primary surgical approach for experienced pancreatic surgeons.
简介
全胰切除术联合胰岛自体移植（TPIAT）可治疗慢性胰腺炎的难治性疼痛，预防急性加重发作，并减轻术后脆性糖尿病。微创（MIS）方法可减少手术创伤和促进康复。我们已经建立了腹腔镜 TPIAT 项目，在此基础上采用机器人方法（R-TPIAT），并研究了与开腹 TPIAT 相比的患者结局。
方法
2013 年至 2021 年，61 名成年患者在经过全面评估（97%为慢性胰腺炎）后接受了 TPIAT。术中在现场分离胰岛。我们分析和比较了术中手术和胰岛特征、术后发病率和死亡率以及 1 年血糖结果。
结果
41 名患者（67%，15 例机器人和 26 例腹腔镜）接受了 MIS-TPIAT，与开腹 TPIAT 相比，重症监护病房住院时间更短（2.9 天 vs. 4.5 天，p=0.002）。R-TPIAT 于 2017 年取代腹腔镜 TPIAT 成为首选的 MIS 方法，与开腹 TPIAT 相比，出血量减少（324 毫升 vs. 843 毫升，p=0.004），手术时间相似（609 分钟 vs. 562 分钟），30 天再入院率（7% vs. 15%）和 90 天并发症率（13% vs. 20%）。血糖结果包括 1 年时 C 肽检测（73% vs. 88%）和 1 年时胰岛素依赖（75% vs. 92%）没有差异。R-TPIAT 后的平均住院时间为 8.6 天，短于腹腔镜（11.5 天，p=0.031）和开腹 TPIAT（12.6 天，p=0.017）。两种 MIS 方法的 1 年死亡率均为 0%。
结论
与开腹 TPIAT 相比，R-TPIAT 可使住院时间缩短 33%（4 天获益）。在可行性、安全性、疼痛控制和 1 年血糖结果方面，R-TPIAT 与开腹 TPIAT 相似。我们的数据表明，机器人技术作为 TPIAT 多学科治疗的新组成部分，有望成为经验丰富的胰腺外科医生的主要手术方法。
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