目的：探讨完全达芬奇机器人手工缝合消化道重建技术在全胃切除术中应用的可行性和安全性。方法：回顾性分析 2015 年 7 月 ~2018 年 6 月东部战区总医院胃癌患者行全胃根治性切除术的临床资料。根据手术方式分为完全机器人全胃切除（Robot-assisted total gastrectomy，RATG）组、腹腔镜辅助全胃切除（Laparoscopic assisted total gastrectomy，LATG）组。RATG 组行机器人镜下腔内手工缝合消化道重建，采用 Uncut Roux-en-Y 重建方案；LATG 组行体外吻合器消化道重建，采用传统 Roux-en-Y 重建方案。观察分析两组患者手术指标、术后康复指标、标本肿瘤学指标、经济学指标及术后并发症情况。结果：两组 100 例患者均顺利完成手术。RATG 组较 LATG 组腹部切口短 [（3.95±0.64）cm Vs （10.38±1.79）cm，P<0.001]，术中出血量少 [（57.10±20.55）ml Vs（98.20±28.44）ml，P<0.001]，但手术时间长 [（201.66±16.59）min Vs（156.14±16.69）min，P<0.001]，消化道重建耗时长 [（56.70±8.78）min Vs （36.60±8.17）min，P<0.001]，住院费用高 [（8.55±1.78）万元 Vs（6.39±0.86）万元，P<0.001]。RATG 组较LATG 组术后住院时间短 [（5.84±4.76）d Vs（6.98±4.31）d，P=0.213]，但差异无统计学意义。两组患者在术后视觉疼痛评分（VAS）、术后 TNM 分期、淋巴结清扫数目、阳性淋巴数目、术后首次排气时间、首次下床活动时间、首次进食流质时间及术后并发症方面的差异均无统计学意（P>0.05）。结论：完全达芬奇机器人手工缝合消化道重建技术在全胃切除术中的应用是安全、可行的。

Objective: To explore the feasibility and safety of manual suturing to reconstruct digestive tract with Da Vinci robot after robot-assisted total gastrectomy. Methods: The clinical data of 100 patients with gastric cancer who underwent robot-assisted total gastrectomy at the General Hospital of Eastern Theater Command from July 2015 to June 2018 was retrospectively analyzed. Patients were divided into robot-assisted total gastrectomy (RATG) group and laparoscopic assisted total gastrectomy (LATG) group. The RATG group was given manual suturing to reconstruct digestive tract with Da Vinci robot after robot-assisted total gastrectomy and the Uncut Roux-en-Y reconstruction. The digestive tract reconstruction was performed to the LATG group with extracorporeal stapler under the traditional Roux-en-Y approach. The operation indexes, postoperative rehabilitation indexes, specimen oncology indexes, economic indicators and postoperative complications were collected and analyzed in the two groups. Results: All the operations were completed successfully. The abdominal incision in the RATG group was shorter than that in the LATG group [(3.95±0.64)cm Vs (10.38±1.79)cm, P<0.001]. The RATG group had less intraoperative blood loss [(57.10±20.55)ml Vs (98.20±28.44)ml, P<0.001], longer operation time [(201.66±16.59) min Vs (156.14±16.69) min, P<0.001] and digestive tract reconstruction time [(56.70±8.78)min Vs(36.60±8.17) min, P<0.001] than that in LATG group.The postoperative hospital stay of RATG group were shorter than the LATG group [(5.84±4.76)d Vs (6.98±4.31)d, P=0.213],which was not statistically significant. However, higher hospitalization costs was taken by the RATG group than the LATG group [(85.50±17.80) thousand CNY Vs (63.90±8.60) thousand CNY, P<0.001]. No statistically significant differences between the two groups on visual pain score (VAS), TNM stage, number of lymph nodes dissected, number of positive lymph nodes, time to first exhaust after surgery, time to first off-bed activity after surgery, time to first fluid intake and incidence of postoperative complications (P>0.05). Conclusion: Manual suturing to reconstruct digestive tract with Da Vinci robot after robot-assisted total gastrectomy is safe and feasible.

收稿日期：2020-11-18  录用日期：2021-02-27

Received Date: 2020-11-18  Accepted Date: 2021-02-27

基金项目：江苏省中医药管理局基金项目（JD201807）；江苏省中医院基金项目（Y19007）

Foundation Item: Foundation of Jiangsu Administration of Traditional Chinese Medicine(JD201807); Foundation of Jiangsu Hospital of Traditional Chinese Medicine(Y19007)

通讯作者：江志伟，Email：surgery34@163.com

Corresponding Author: JIANG Zhiwei, Email: surgery34@163.com

引用格式：刘江，王刚，冯啸波，等 . 完全机器人手工缝合消化道重建技术在全胃切除术中的应用 [J]. 机器人外科学杂志（中英文），2021，2（3）：151-161.

Citation: LIU J, WANG G, FENG X B, et al. Application of manual suturing to reconstruct digestive tract after robot-assisted total gastrectomy [J]. Chinese Journal of Robotic Surgery,  2021, 2(3):151-161.

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