目的：探讨机器人辅助腹腔镜手术治疗宫颈癌中运用膜解剖理念的优势。方法：回顾性分析 2020 年 3 月—2023 年 3 月在厦门大学附属第一医院行机器人辅助手术的 36 例宫颈癌患者的临床资料，其中 14 例运用膜解 剖理念进行手术的患者分为膜解剖组，22 例传统解剖理念下进行手术的患者分为传统解剖组。比较两组患者的基本 资料及手术时间、平均术中出血量、平均拔除尿管后残余尿量、平均术后住院时间等手术相关指标。结果：36 例患 者均顺利完成手术，无中转开腹病例。两组患者手术相关指标相比，膜解剖组患者手术时间更短，平均术中失血量 更少，平均拔除尿管后残余尿量更少，平均术后住院时间更短，差异具有统计学意义（P<0.05）。膜解剖组患者暴 露盆丛比例高于传统解剖组（92.86% Vs 36.36%），两组患者暴露深静脉并离断比例均为 100%。结论：运用膜解剖 理念在机器人辅助腹腔镜下宫颈癌根治术中优势明显。

Objective: To explore the advantages of using membrane anatomy in robot-assisted laparoscopic surgery for cervical cancer. Methods: A retrospective analysis was conducted on the clinical data of 36 cervical cancer patients who underwent robot-assisted laparoscopic surgery at the First Affiliated Hospital of Xiamen University from March 2020 to August 2023. Among them, 14 patients underwent the surgery based on the concept of membrane anatomy were divided into the membrane anatomy group and 22 patients underwent the surgery with conventional anatomy into the conventional anatomy group. The basic data, operative time, average intraoperative blood loss, average volume of residual urine after catheter removal, average length of hospital stay and other surgical indicators were compared between the two groups of patients. Results: All surgeries was successfully completed without conversion to open surgery. Compared with the conventional anatomy group in surgical indicators, patients in the membrane anatomy group had shorter operative time, less average intraoperative blood loss, less average volume of residual urine after catheter removal, and shorter average length of hospital stay, and the differences were statistically significant (P< 0.05). The proportion of exposed pelvic plexus in the membrane anatomy group was higher than that in the conventional anatomy group (92.86% Vs 36.36%), and the proportion of exposed and dissected deep veins in the two groups were both 100%. Conclusion: The application of membrane anatomy concept in robot-assisted laparoscopic surgery for cervical cancer has obvious advantages.

收稿日期：2023-10-02  录用日期：2023-12-26 

Received Date: 2023-10-02  Accepted Date: 2023-12-26 

基金项目：国家自然科学基金（82271678）；福建省自然科学基金（2021J011347） 

Foundation Item: National Natural Science Foundation of China(82271678); Natural Science Foundation of Fujian Province (2021J011347) 

通讯作者：陈琼华，Email：cqhua616@126.com 

Corresponding Author: CHEN Qionghua, Email: cqhua616@126.com 

引用格式：林典超，蓝建发，陈琼华 . 膜解剖理念相较于传统解剖理念在机器人辅助腹腔镜下宫颈癌根治术中的优势探讨 [J]. 机器 人外科学杂志（中英文），2024，5（4）：575-580. 

Citation: LIN D C, LAN J F, CHEN Q H. Superiorities of robot-assisted radical surgery for cervical cancer based on the concept of membrane anatomy over conventional anatomy (with surgical video)[J]. Chinese Journal of Robotic Surgery, 2024, 5(4): 575-580.

[1] Rebecca L S, Kimberly D M, Nikita S W, et al. Cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73(1): 17-48. 

[2] Edlis A, Bundy B N, Rotman M Z, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study[J]. Gynecol Oncol, 1999, 73(2): 177-183.

[3] Uppal S, Liu J R, Reynolds R K, et al. Trends and comparative effectiveness of inpatient radical hysterectomy for cervical cancer in the United States (2012-2015) [J]. Gynecol Oncol, 2019, 152(1): 133-138. 

[4] CAO L, XU H, CHEN Y, et al. A detailed analysis of the learning curve: da vinci robot-assisted radical hysterectomy in cervical cancer [J]. J Minim Invasive Gynecol, 2015, 22(6S): S228-S229. 

[5] Alkatout I, Mettler L, Maass N, et al. Robotic surgery in gynecology[J]. J Turk Ger Gynecol Assoc, 2016, 17(4): 224-232. 

[6] 韩世超 , 那晶 , 李亚 , 等 . 膜解剖理念在机器人辅助腹腔镜下 宫颈癌手术的应用及展望 [J]. 机器人外科学杂志 , 2023, 4(5): 456-463. 

[7] MacFarlane J K, Ryall R D, Heald R J. Mesorectal excision for rectal cancer[J].Lancet, 1993, 341(8843): 457-460. 

[8] SU X Y, LYU Y, WANG W Y, et al. Fascia origin of adipose cells[J]. Stem Cells, 2016, 34(5): 1407-1419. 

[9] 龚建平 . 膜解剖的兴起与混淆 [J]. 中华胃肠外科杂志 , 2019, 22(5): 401-405. 

[10] ZHAO X F, OUYANG Y L. Demystifying membrane anatomy: toward a new era of abdominopelvic surgery[J]. The Innovation, 2023, 4(1): 100370. 

[11] Brian S P, Priscila R A, Crystal K, et al. Review of emerging surgical robotic technology[J]. Surg Endosc, 2018, 32(4): 1636-1655. 

[12] Ramirez P T, Adams S, Boggess J F, et al. Robotic assisted surgery in gynecologic oncology: a society of gynecologic oncology consensus statement. Developed by the society of gynecologic oncology’s clinical practice robotics task force[J]. Gynecol Oncol, 2012, 124(2): 180-184. 

[13] Koh W J, Greer B E, Abu-Rustum N R, et al. Cervical Cancer, Version 2.2015[J]. J Natl Compr Canc Netw, 2015, 13(4): 395-404. 

[14] 吕小慧 , 陈必良 . 达芬奇机器人手术系统在妇科手术中的应用[J]. 机器人外科学杂志( 中英文 ), 2020，1(1):  57-60.

[15] Marchal  F, Rauch P, Vandromme  J, et al. Telerobotic. assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients[J]. Surg Endosc, 2005, 19(6): 826-831. 

[16] Sert B M, Abeler V M. Robotic-assisted laparoscopic radical hysterectomy (Piver type Ⅲ) with pelvic node dissection-case report[J]. Eur J Gynaecol Oncol, 2006, 27(5): 531-533.

[17] LIU Y F, JI M, ZHAO Z, et al. Comparison of robot-assisted Vs conventional laparoscopic radical hysterectomy for stage ⅠB1- ⅡA2 cervical cancer and analysis on influencing factors of postoperative complications [J]. Chinese Journal of Robotic Surgery, 2023, 4(5): 397-406. 

[18] Sang I K, Ji G Y, Sung J L, et al. Robot-assisted versus conventional laparoscopic radical hysterectomy in cervical cancer stage ⅠB1 [J]. Int J Med Sci, 2023, 20(3): 287-291. 

[19] JIN Y M, LIU S S, CHEN J, et al. Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer[J]. PloS One, 2018, 13(3): e0193033. 

[20] Abu-Rustum N R, Yashar C M, Bean S, et al. NCCN guidelines insights: Cervical cancer, version 1.2020 [J]. J Natl Compr  Canc Netw, 2020, 18(6): 660-666. 

[21] Ngo 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. 

[22] Höckel M, Wolf B, Schmidt K, et al. Surgical resection based on ontogenetic cancer field theory for cervical cancer: mature results from a single-centre, prospective, observational, cohort study[J]. The Lancet Oncology, 2019, 20(9): 1316-1326. 

[23] Arian S E, Munoz J L, Kim S, et al. Robot-assisted laparoscopic myomectomy: current status[J]. Robotic Surgery: Research and Reviews, 2017, 23(4): 7-18. 

[24] Höckel M. Morphogenetic fields of embryonic development in locoregional cancer spread[J]. Lancet Oncol, 2015, 16(3): e148-151.