探讨达芬奇机器人手术系统在妇科手术中的安全性、可行性及临床应用价值。方法：回顾性分析重庆医科大学附属第一医院妇科于 2016 年 2 月 ~2019 年 11 月实施的 606 例妇科良性及恶性疾病患者的临床资料及近期疗效。结果：全部手术均在无中转开腹的情况下顺利完成，其中宫颈恶性肿瘤占 66%（400/606）、子宫内膜恶性肿瘤占 15.02%（91/606）、卵巢恶性肿瘤占 2.64%（16/606），外阴及阴道恶性肿瘤占 0.83%（5/606）。手术时间平均（143.83±43.99） min，术中出血量平均（77.34±63.24）ml，术后肠道功能恢复时间平均（1.90±0.64）d，术后平均住院（6.20±1.49）d，术中并发症发生率为 0.33%。结论：达芬奇机器人手术系统应用于妇科手术在手术时间、术中出血量、术中术后并发症等方面具有一定优势，尤其是在行妇科高难度恶性肿瘤手术中可明显降低术中并发症的发生，具有很好的安全性及可行性。

To explore the safety, feasibility and clinical value of Da Vinci surgical system in gynecological surgery. Methods: The clinical data and short-term effect of 606 women who underwent Da Vinci robotic-assisted laparoscopic surgery due to benign or malignant gynecological disease from February 2016 to November 2019 in gynecology department of the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. Results: All surgeries were successfully completed without any conversion, among which cervical cancer accounted for 66% (400/606), endometrial cancer 15.02% (91/606), ovarian cancer 2.64% (16/606), vulva cancer and vagina cancer 0.83% (5/606).The average operative time was (143.83±43.99) min, the average intraoperative blood loss was (77.34±63.24) ml, the average recovery time of intestinal function was (1.90±0.64) d and the average length of postoperative hospital stay was (6.20±1.49) d. Conclusion: Da Vinci surgical system is safe and feasible in gynecological surgery. Furthermore, obvious advantages have been shown in terms of operative time, intraoperative blood loss, intraoperative and postoperative complications in Da Vinci surgical system, especially the intraoperative complications are significantly reduced in complicated gynecological cancer surgery.

收稿日期：2020-02-18  录用日期：2020-05-10

Received Date: 2020-02-18  Accepted Date: 2020-05-10

基金项目：重庆市科委项目（cstc2015shmszx120085）

Foundation Item: Scientific and Technological project of Chongqing Municipality (cstc2015shmszx120085)

通讯作者：唐均英，Email：tangjy_cqmu@sina.com

Corresponding Author: TANG Junying, Email: tangjy_cqmu@sina.com

引用格式：欧阳熙坪，李津津，龚雪，等 . 达芬奇机器人手术系统行妇科手术 606 例临床分析 [J]. 机器人外科学杂志，2020，1（2）：102-107.

Citation: OUYANG X P, LI J J, GONG X, et al. Clinical analysis on 606 cases of gynecological surgery performed with Da Vinci surgical system[J]. Chinese Journal of Robotic Surgery, 2020, 1 (2): 102-107.

[1] Jeong I G, Khandwala Y S, Kim J H, et al. Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015[J]. JAMA, 2017, 318 (16): 1561-1568. 

[2] CHENG C L, Rezac C.The role of robotics in colorectal surgery[J]. BMJ, 2018. DOI: 10.1136/bmj.j5304. 

[3] Spaggiari L, Sedda G, Maisonneuve P, et al. A Brief Report on Survival After Robotic Lobectomy for EarlyStage Lung Cancer[J]. J Thorac Oncol, 2019, 14 (12): 2176-2180. 

[4] Alfonzo E, Wallin E, Ekdahl L, et al.No survival difference between robotic and open radical hysterectomy for women with early-stage cervical cancer: results from a nationwide population-based cohort study[J]. Eur J Cancer, 2019, 116 (5): 169-177. 

[5] James J A, Rakowski J A, Jeppson C N, et al.Robotic transperitoneal infra-renal aortic lymphadenectomy in early-stage endometrial cancer[J]. Gynecol Oncol, 2015, 136 (2): 285-292. 

[6] Facer B, Wang F, Grijalva C G, et al.Survival Outcomes for Robotic-Assisted Laparoscopy Versus Traditional Laparoscopy in Clinical Stage I Epithelial Ovarian Cancer[J]. Am J Obstet Gynecol, 2020, 222 (5): 474.e1- 474.e12. 

[7] Medlin E E, Kushner D M, Barroilhet L.Robotic surgery for early stage cervical cancer: Evolution and current trends[J]. J Surg Oncol, 2015, 112 (7): 772-781. 

[8] Bogani G, Leone Roberti Maggiore U, Rossetti D, et al.Advances in laparoscopic surgery for cervical cancer [J]. Crit Rev Oncol Hematol, 2019, 143 (7): 76-80. 

[9] Fader A N.Minimally Invasive Techniques for Treating Gynecologic Malignancies[J]. J Natl Compr Canc Netw, 2017, 15 (5S): 730-732. 

[10] Ngô C, Cornou C, Rossi L, et al.Evidence for the use of robotically assisted surgery in gynecologic cancers[J]. Curr Opin Oncol, 2016, 28 (5): 398-403. 

[11] Sinno A K, Fader A N.Robotic-assisted surgery in gynecologic oncology[J]. Fertil Steril, 2014, 102 (4): 922-932. 

[12] YANG Q, TANG J, XIAO L.Disease-free survival after robotic-assisted laparoscopic total pelvic exenteration for recurrent cervical adenocarcinoma: A case report[J]. Medicine (Baltimore), 2018, 97 (30): e11611. 

[13] Sert B M, Boggess J F, Ahmad S, et al.Robot-assisted versus open radical hysterectomy: A multi-institutional experience for early-stage cervical cancer[J]. Eur J Surg Oncol, 2016, 42 (4): 513-522. 

[14] Lim P C, Kang E, Park D H.A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients[J]. Gynecol Oncol, 2011, 120 (3): 413-418. 

[15] YANG Z J, CHEN Y L, YAO D S, et al.Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy to Patients With Early-Stage Cervical Cancer[J]. Zhonghua Fu Chan Ke Za Zhi, 2011, 46 (11): 854-859. 

[16] Matern T, Kang E, Lim P C. Factors in the feasibility and safety of outpatient robotic-assisted hysterectomy for endometrial or cervical carcinoma[J]. Gynecol Oncol, 2020, 157 (2): 482-486. 

[17] Madden N, Frey M K, Joo L, et al.Safety of roboticassisted gynecologic surgery and early hospital discharge in elderly patients[J]. Am J Obstet Gynecol, 2019, 220 (3): 253.e1-253.e7.