卵巢癌是一种威胁女性健康的恶性肿瘤，恶性程度高，病死率居妇科肿瘤之首，手术是其主要的治疗方式。随着科技的进步，研究者在腹腔镜手术原理的基础上，开发了更加精准的达芬奇机器人手术系统，其具有微创、精细、灵活、滤抖等诸多优点，并引领着妇科手术迈向精准医疗的新征程。作为一种新兴的手术方式，机器人手术在卵巢癌的治疗与应用中存在诸多争议。本研究主要针对卵巢癌治疗的现状与争议进行深入剖析，对比分析机器人、腹腔镜及开腹手术治疗卵巢癌的手术疗效，并对机器人手术的发展及应用进行展望。

Ovarian cancer is a malignant tumor threatening women’s health. Its fatality rate ranks the first among gynecological tumors. Ovarian cancer has a high degree of malignancy and surgery is the main treatment way. With the advancement of science and technology, researchers proposed the more accurate robotic surgical system based on the principle of laparoscopic surgery. It has many advantages such as minimally invasive, precision, flexibility, tremor filtering and so on,leading a new journey of gynecological surgery to precision medicine. However, as an emerging surgical method, there are many controversies about the treatment and application of robotic surgery in ovarian cancer at home and abroad.In this paper, an indepth analysis on the current situation and controversies in treating ovarian cancer were conducted, a comparative analysis on the surgical efficacy of robotic, laparoscopic and open surgery in the treatment of ovarian cancer were made, and the development

and application of robotic surgery were prospected.

收稿日期：2021-06-12 录用日期：2021-10-20

Received Date: 2021-06-12 Accepted Date: 2021-10-20

基金项目：陕西省重点研发项目（2021SF-005）

Foundation Item: The Key R & D Projects of Shaanxi Province (2021SF-005)

通讯作者：朱晓明，Email：rao_yu_zxm@163.com

Corresponding Author: ZHU Xiaoming, Email: rao_yu_zxm@163.com

引用格式：李佳璐，汤译博，朱晓明.机器人手术系统在卵巢癌治疗中的应用进展[J]. 机器人外科学杂志（中英文），2022，3（3）：240-245.

Citation: LI J L, TANG Y B, ZHU X M. Application progress of robotic surgical system in the treatment of ovarian cancer[J]. Chinese Journal of Robotic Surgery, 2022, 3(3):240-245.

[1] Siegel R L, Miller K D, Statistics J C, et al. Cancer statistics, 2015.CA[J]. A Cancer J Clinicians, 2015,65(1): 5-29.

[2] Kimmig R, Iannaccone A, Buderath P, et al. Definition of compartment based radical surgery in uterine cancer part I: therapeutic pelvic and periaortic lymphadenectomy by Michael Höckel translated to robotic surgery[J]. ISRN Obstet Gynecol, 2013.DOI:10.1155/2013/297921.

[3] Magrina J F, Zanagnolo V, Noble B N, et al. Robotic approach for ovarian cancer: perioperative and survival results and comparison with laparoscopy and laparotomy[J]. Gynecol Oncol, 2011, 121(1): 100-105.

[4] Julian P, Sally G. Cochrane handbook for systematic reviews of interventions version 5.1.0[EB/OL].http: //www.cochrane-hand-book.Org.

[5] Ovarian Cancer: Evidence Update January 2013: a summary of selected new evidence relevant to NICE clinical guideline 122‘The recognition and initial management of ovarian cancer’(2011)[M].London:National Institute for Health and Clinical Excellence

(UK), 2013: 1-30.

[6] Jung U S, Lee J H, Kyung M S, et al. Feasibility and efficacy of laparoscopic management of ovarian cancer[J]. J Obstet Gynaecol Res, 2009, 35(1): 113-118.

[7] Colomer A T, Jimenez A M, Barcelo M. Laparoscopic treatment and staging of early ovarian cancer[J]. J Minim Invasive Gynecol, 2008, 15(4): 414-419.

[8] 李妍, 张楠, 田赟, 等. 对比开腹手术与腹腔镜手术治疗早期卵巢癌的临床效果[J]. 实用妇科内分泌杂志( 电子版), 2019, 6(5): 69-71.

[9] Corrado G, Mancini E, Cutillo G, et al. Laparoscopic debulking surgery in the management of advanced ovarian cancer after neoadjuvant chemotherapy[J]. Int J Gynecol Cancer, 2015, 25(7): 1253-1257.

[10] Martinelli F, Ditto A, Bogani G, et al. Laparoscopy compared with laparotomy for debulking ovarian cancer after neoadjuvant chemotherapy[J]. Obstet Gynecol,2017, 130(2): 469-470.

[11] Lucidi A, Chiantera V, Gallotta V, et al. Role of robotic surgery in ovarian malignancy[J]. Best Pract Res Clin Obstet Gynaecol, 2017. DOI: 10.1016/j.bpobgyn.2017.05.005.

[12] 许鹏琳, 纪妹, 赵曌, 等. 达芬奇机器人手术系统在早期卵巢癌分期手术中的应用价值研究[J]. 中国实用妇科与产科杂志, 2017, 33(10): 1077-1079.

[13] Nezhat F R, Finger T N, Vetere P, et al. Comparison of perioperative outcomes and complication rates between conventional versus robotic-assisted laparoscopy in the evaluation and management of early, advanced, and recurrent stage ovarian, fallopian tube, and primary

peritoneal cancer[J]. Int J Gynecol Cancer, 2014, 24(3):600-607.

[14] CHEN C H, CHIU L H, CHEN H H, et al. Comparison of robotic approach, laparoscopic approach and laparotomy in treating epithelial ovarian cancer[J]. Int J Med Robot, 2016, 12(2): 268-275.

[15] Farghaly S A. Robotic-assisted laparoscopic anterior pelvic exenteration in patients with advanced ovarian cancer: Farghaly’s technique[J]. Eur J Gynaecol Oncol,2010, 31(4): 361-363.

[16] Kehoe S, Hook J, Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial[J]. Lancet, 2015, 386(9990): 249-257.

[17] Ackroyd S A, Thomas S, Angel C, et al. Interval robotic cytoreduction following neoadjuvant chemotherapy in advanced ovarian cancer[J]. J Robot Surg, 2018, 12(2):245-250.

[18] 陈淑英. 达芬奇机器人手术系统与传统腹腔镜在晚期卵巢癌手术中应用的对比研究[D]. 郑州大学,2019.

[19] Ramirez P T, Wolf J K, Levenback C. Laparoscopic port-site metastases: etiology and prevention[J]. Gynecol Oncol, 2003, 91(1): 179-189.

[20] Lönnerfors C, Bossmar T, Persson J. Port-site metastases following robot-assisted laparoscopic surgery for gynecological malignancies[J]. Acta Obstet Gynecol Scand, 2013, 92(12): 1361-1368.

[21] Ndofor B T, Soliman P T, Schmeler K M, et al. Rate of port-site metastasis is uncommon in patients undergoing robotic surgery for gynecological malignancies[J]. Int J Gynecol Cancer, 2011, 21(5): 936-940.

[22] Papparella A, Nino F, Coppola S, et al. Peritoneal morphological changes due to pneumoperitoneum: the effect of intra-abdominal pressure[J]. Eur J Pediatr Surg,2014, 24(4): 322-327.

[23] Lécuru F, Agostini A, Camatte S, et al. Impact of pneumoperitoneum on visceral metastasis rate and survival. Results in two ovarian cancer models in rats[J].BJOG, 2001, 108(7): 733-737.

[24] Lécuru F, Agostini A, Camatte S, et al. Impact of pneumoperitoneum on tumor growth[J]. Surg Endosc,2002, 16(8): 1170-1174.

[25] Mourits M J, Bijen C B, Arts H J, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial[J]. Lancet Oncol,2010, 11(8): 763-771.

[26] Trimbos J B, Vergote I, Bolis G, et al. Impact of adjuvant chemotherapy and surgical staging in earlystage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant Chemo-Therapy in Ovarian Neoplasm trail[J]. J Natl Cancer Inst, 2003, 95(2): 113-125.

[27] Iavazzo C, Gkegkes I D. Cost-benefit analysis of robotic surgery in gynaecological oncology[J]. Best Pract Res Clin Obstet Gynsrcol, 2017.DOI: 10.1016/j.bpobgyn.2017.03.008.