目的：探讨全机器人下前入路联合右后入路法行胰十二指肠切除术（Pancreaticoduodenectomy，PD）的 安全性及有效性分析。方法：回顾性分析甘肃省人民医院普外临床中心 2018—2020 年收治并行 PD 术式的 45 例患 者的临床资料，其中 39 例符合纳入标准，将其分为 LPD 组与 TRPD 组（两组患者皆行前入路与右后入路联合术式）。 观察联合入路在术中的应用，分析患者的 R0 切除率、手术时程、术中出血量、PV-SMV 血管轴解剖时间、钩突系 膜处理时间、消化道重建时间、术中副损伤、术后拔除胃管时间、首次进食时间、术后住院时间及术后并发症等。 采用 SPSS 25.0 统计学软件对所有数据进行分析。结果：两组患者均成功实施 PD，无中转开腹病例；术后病检结果 显示，胰腺癌 24 例、十二指肠乳头癌 7 例、胆管下段癌 5 例、壶腹癌 3 例。TRPD 组与 LPD 组术中及术后指标比较， 差异有统计学意义（P<0.05）；两组淋巴结清扫数目相比，差异无统计学意义（P>0.05）；两组患者术后出现胃排空障 碍、胆瘘、胰瘘、术后出血、术后感染的发生率及总发生率相比较，差异无统计学意义（P>0.05）；术后均无死亡病例。 结论：全机器人下前入路与右后入路联合进行胰十二指肠切除术安全、可行。

Objective: To explore the safety and effectiveness of totally robot-assisted pancreaticoduodenectomy with anterior approach and right posterior approach. Methods: The clinical data of 45 patients underwent robotic PD surgery in Gansu Provincial Hospital from 2018 to 2020 were retrospectively analyzed. 39 cases of which were selected into the study and divided into LPD (Laparoscopic pancreaticoduodenectomy) group and TRPD (Totally robotic pancreaticoduodenectomy) group. Both the two groups of surgery were performed under anterior approach combined right posterior approach. The application of combined approaches was observed. R0 resection rate, operation time, intraoperative blood loss, PV-SMV vascular resection time, uncinate mesangial treatment time, digestive tract reconstruction time, intraoperative collateral injury, postoperative removal time of gastric tube, first meal time, postoperative hospital stay, postoperative complications were collected and analyzed with SPSS 25.0 statistical software. Results: All surgeries were successfully completed without conversion to laparotomy. The postoperative pathological findings showed that there were 24 cases of pancreatic cancer, 7 cases of duodenal papillary cancer, 5 cases of lower bile duct cancer, and 3 cases of ampullary cancer. Intraoperative and postoperative indexes between the TRPD group and the LPD group were statistically different (P<0.05). No significant difference on the number of lymph node dissections between the two groups was found (P>0.05). The incidence and total incidence of gastric emptying disorders, biliary fistula occurred pancreatic fistula, postoperative hemorrhage and postoperative infection in the two groups after surgery were not statistically different (P>0.05). No death occurred after surgery. Conclusion: It is safe and feasible to perform totally robotic pancreaticoduodenectomy through the combination of anterior approach and right posterior approach.

收稿日期：2021-03-23  录用日期：2022-03-30

Received Date: 2021-03-23  Accepted Date: 2022-03-30 

基金项目：甘肃省外科肿瘤分子诊断与精准治疗重点实验室开放基金（2019GSZDSYS04）

Foundation Item: Open Foundation of Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province (2019GSZDSYS04)

通讯作者：马云涛，Email：3575515665@qq.com 

Corresponding Author: MA Yuntao, Email: 3575515665@qq.com 

引用格式：何兴龙，许永成，马雕龙，等 . 全机器人下前入路联合右后入路法行胰十二指肠切除术的安全性及有效性分析 [J]. 机器 人外科学杂志（中英文），2022，3（6）：456-463.

Citation: HE X L, XU Y C, MA D L, et al. Analysis on the safety and effectiveness of totally robotic pancreaticoduodenectomy under anterior approach combined with right posterior approach [J]. Chinese Journal of Robotic Surgery, 2022, 3 (6): 456-463.

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