Advertisement
中国的机器人外科学杂志 | ISSN 2096-7721 | CN 10-1650/R

机器人辅助乳腺癌腋窝淋巴结清扫术的初步探索(附手术视频)

Early experience of robot-assisted axillary lymph node dissection for breast cancer (with surgical video)

作者:陈阔,吕鹏威

Vol. 6 No. 2 Feb. 2025 DOI: 10.12180/j.issn.2096-7721.2025.02.029 发布日期:2025-03-24
关键词:乳腺癌;机器人辅助手术;淋巴结清扫术;腋窝

作者简介:

目的:探讨与评估对乳腺癌患者进行机器人辅助腋窝淋巴结清扫术(RALND)的可行性和安全性。方法:回顾性分 析郑州大学第一附属医院乳腺外科于 2021 年 3 月—2024 年 3 月完成机器人辅助下保留乳头乳晕乳腺切除术联合假体即刻乳 房重建术(R-NSM-IBR)且需要进行腋窝淋巴结清扫术的 60 例乳腺癌患者的临床资料,将患者分为两组,每组 30 例,对照 组行传统腋窝淋巴结清扫术(CALND),研究组采用达芬奇机器人 Xi 手术系统行 RALND。分析两组患者的临床病理特征和 手术结果数据。结果:两组患者一般资料比较差异无统计学意义。研究组患者手术时间略长于对照组,但两组患者手术时间、 腋窝淋巴结阳性数目以及术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:就早期手术效果而言,RALND 安 全可行,与 CALND 临床效果相当。

Objective: To explore and evaluate the feasibility and safety of robot-assisted axillary lymph node dissection (RALND) in patients with breast cancer. Methods: 60 breast cancer patients who underwent robot-assisted nipple-sparing mastectomy and immediate axillary lymph node reconstruction (R-NSM-IBR) with the requiement of axillary lymph node dissection in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. They were divided into the control group and the study group according to different surgical methods, with 30 cases in each group. The control group were treated with conventional axillary lymph node dissection (CALND) and the study group underwent RALND using the Da Vinci Xi Robotic Surgical System. The clinicopathological characteristics and surgical outcomes of the two groups were analyzed. Results: There was no statistically significant difference in the general data of the two groups. The operative time in the study group was slightly longer than that of the control group, but the differences in the operative time, the number of positive axillary lymph node, and the incidence of postoperative complications of the two groups were not statistically significant (P>0.05). Conclusion: In terms of early surgical outcomes, RALND is safe and feasible, and is comparable to CALND with respect to clinical outcomes.

稿件信息

引用格式:陈阔,吕鹏威 . 机器人辅助乳腺癌腋窝淋巴结清扫术的初步探索(附手术视频)[J]. 机器人外科学杂志(中英文),2025,6(2): 349-354. 

Citation: CHEN K, LYU P W. Early experience of robot-assisted axillary lymph node dissection for breast cancer (with surgical video)[J].  Chinese Journal of Robotic Surgery, 2025,6(2): 349-354.

通讯作者(Corresponding Author):吕鹏威(LYU Pengwei),Email:lvpengwei1983@hotmail.com

参考文献

[1] Zhang X, Beeraka N M, Sinelnikov M Y, et al. Breast cancer-related lymphedema: recent updates on clinical efficacy of therapies and bioengineering approaches for a personalized therapy[J]. Curr Pharm Des, 2024, 30(1): 63-70. 

[2] de Boniface J, Filtenborg Tvedskov T, Rydén L, et al. Omitting axillary dissection in breast cancer with sentinel-node metastases[J]. N Engl J Med, 2024, 390(13): 1163-1175. 

[3] Giuliano A E, Ballman K V, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial[J]. JAMA, 2017, 318(10): 918-926. 

[4] 陈阔 , 吕鹏威 . 达芬奇机器人乳腺外科手术 151 例 [J]. 中华普通外科 杂志 , 2024, 39(7): 516-520. 

[5] Chen K, Zhang J, Beeraka N M, et al. Robotic nipple sparing mastectomy and immediate breast reconstruction: significant attempts with the latissimus dorsi muscle without island flap[J]. Minerva Surg, 2024, 79(4): 411-418. 

[6] 李永康 , 梁苗 , 王延洲 , 等 . 机器人辅助腹腔镜技术在腹股沟淋巴结 切除术中的应用 [J]. 机器人外科学杂志 ( 中英文 ), 2024, 5(3): 489- 494. 

[7] 李超 , 郝迎学 . 达芬奇机器人辅助髂动脉溃疡切除重建术 [J]. 机器人 外科学杂志 ( 中英文 ), 2024, 5(3): 438. 

[8] 赵栎珺 , 张亚敏 , 蔺黎 , 等 . 达芬奇机器人辅助全子宫切除术后患者 正念影响因素的线性回归及改善策略分析 [J]. 机器人外科学杂志 ( 中 英文 ), 2024, 5(3): 466-471. 

[9] 陈阔 , 吕鹏威 . 达芬奇机器人保留乳头乳晕乳腺切除即刻假体乳房 重建术中预防热蒸汽损伤皮肤组织临床研究 [J]. 中国修复重建外科 杂志 , 2024, 38(7): 813-817. 

[10] Chen K, Zhang J, Beeraka N M, et al. Robot-assisted minimally invasive breast surgery: recent evidence with comparative clinical outcomes[J]. J Clin Med, 2022, 11(7): 1827. 

[11] Chen K, Zhang J, Beeraka N M, et al. Robot-assisted nipple-sparing mastectomy and immediate breast reconstruction with gel implant and latissimus dorsi muscle flap: our initial experience[J]. Int J Med Robot, 2023, 19(5): e2528. 

[12] Kim J H, Ryu J M, Bae S J, et al. Minimal access vs conventional nipplesparing mastectomy[J]. JAMA Surg, 2024, 159(10): 1177-1186.

[13] Vourtsis S A, Paspala A, Lykoudis P M, et al. Robotic-assisted harvest of latissimus dorsi muscle flap for breast reconstruction: review of the literature[J]. J Robot Surg, 2022, 16(1): 15-19. 

[14] Toesca A, Peradze N, Galimberti V, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique[J]. Ann Surg, 2017, 266(2): e28-e30. 

[15] Toesca A, Park H S, Ryu J M, et al. Robot-assisted mastectomy: next major advance in breast cancer surgery[J]. Br J Surg, 2023, 110(4): 502-503. 

[16] Ryu J M, Kim J Y, Choi H J, et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction: an initial experience of the Korea robot-endoscopy minimal access breast surgery study group (KoREa-BSG)[J]. Ann Surg, 2022, 275(5): 985-991. 

[17] 中国医师协会医学机器人医师分会小儿外科专业委员会 , 中国妇幼 保健协会妇幼微创专业委员会 . 机器人辅助儿童先天性胆总管囊肿 手术中国专家共识 (2022 版 )[J]. 机器人外科学杂志 ( 中英文 ), 2023, 4(4): 376-388. 

[18] 孙寒星 , 严佶祺 . 机器人辅助甲状腺手术的现状与展望 [J]. 机器人外 科学杂志 ( 中英文 ), 2023, 4(1): 18-24. 

[19] Chen K, M Beeraka N, Zhang J, et al. Efficacy of da Vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer - a comparative study[J]. Int J Med Robot, 2021, 17(6): e2307. 

[20] Ahn J H, Park J M, Choi S B, et al. Early experience of robotic axillary lymph node dissection in patients with node-positive breast cancer[J]. Breast Cancer Res Treat, 2023, 198(3): 405-412. 

[21] LAI H W, CHEN S T, TAI C M, et al. Robotic-versus endoscopic-assisted nipple-sparing mastectomy with immediate prosthesis breast reconstruction in the management of breast cancer: a case-control comparison study with analysis of clinical outcomes, learning curve, patient-reported aesthetic results, and medical cost[J]. Ann Surg Oncol, 2020, 27(7): 2255-2268. 

[22] Kim J K, Lee C R, Kang S W, et al. Expansion of thyroid surgical territory through 10, 000 cases under the da Vinci robotic knife[J]. Sci Rep, 2024, 14(1): 7555. 

[23] Kim K H, Ji Y B, Song C M, et al. Learning curve of transoral robotic thyroidectomy[J]. Surgical Endoscopy, 2023, 37(1): 535-543. 

[24] Afferi L, Baumeister P, Fankhauser C, et al. Nerve-sparing robot-assisted retroperitoneal lymph node dissection: the monoblock technique[J]. Eur Urol Open Sci, 2021, 32(13): 1-7. 

[25] Roshan A, Shah B, Anderson K D, et al. Robot-assisted pelvic dissection for enlarged lymph nodes in melanoma improves recovery with equivalent oncological outcomes to open pelvic dissection[J]. Ann Surg Oncol, 2024, 31(4): 2727-2736. 

[26] 刘召 , 谢毅 , 朱含放 . 机器人与腹腔镜行胃癌 D2 根治性淋巴结清扫 术近期疗效对比的 Meta 分析 [J]. 机器人外科学杂志 ( 中英文 ), 2022, 3(4): 295-310. 

[27] 胡家亮 , 邓溧 , 汤译博 , 等 . 机器人手术系统在妇科腹主动脉旁淋 巴结清扫中的应用进展 [J]. 机器人外科学杂志 ( 中英文 ), 2021, 2(5): 335-341. 

[28] 吴芃 , 黄芃铖 , 钟家雷 . 前列腺癌中机器人辅助超扩大盆腔淋巴结 清扫术的标准化和简化流程 [J]. 机器人外科学杂志 ( 中英文 ), 2020, 1(1): 71. 

[29] Lee H, Lee J, Lee K, et al. Comparison between gasless and gas-inflated robot-assisted nipple-sparing mastectomy[J]. J Breast Cancer, 2021, 24(2): 183-195. 

[30] XU P F, FANG Q, MAI J H, et al. Gasless robot-assisted transaxillary hemithyroidectomy (RATH): learning curve and complications[J]. BMC Surgery, 2024, 24(1): 78.

本期文章
[1] 机器人辅助乳腺癌腋窝淋巴结清扫术的初步探索(附手术视频) [2] 机器人辅助腹腔镜下盆腔脓肿清除术一例报道(附手术视频) [3] 机器人辅助胃癌根治术的优势及局限性 [4] 机器人辅助经腹宫颈环扎术的临床应用及技巧(附手术视频) [5] 机器人辅助食管癌根治术的应用现状与研究进展 [6] 机器人食管 Ivor Lewis 手术的临床应用 [7] CICARE 沟通模式联合健康教育在机器人辅助结肠癌手术患者中的效果 [8] 达芬奇手术机器人辅助胆囊癌根治术中加速康复护理与疼痛管理应用效果的评估 [9] 机器人辅助腔内手术治疗主动脉瘤患者的围手术期护理 [10] 建构主义理论教考联动模式用于机器人辅助手术护理带教对教学质量的影响 [11] 基于岗位胜任力的达芬奇机器人手术护士培训现状研究 [12] 脑卒中患者上肢机器人辅助训练文献的可视化分析 [13] 外骨骼机器人辅助康复训练对脊髓损伤患者的影响 [14] 下肢康复机器人联合针灸治疗在脑卒中偏瘫患者中的应用 [15] 下肢康复机器人联合康复锻炼治疗脑卒中患者步行障碍的效果观察 [16] 下肢外骨骼机器人在脊髓损伤患者康复过程中的应用及效果观察 [17] 康复机器人辅助训练在脑卒中后上肢功能障碍患者中的应用分析 [18] 环泊酚在机器人辅助腹腔镜下根治性前列腺癌切除术中的应用 [19] 丙泊酚靶控输注麻醉与七氟烷吸入麻醉对机器人辅助腹腔镜下根治性前列腺切除术中患者脑氧代谢及认知功能的影响 [20] 不同剂量右美托咪定联合盐酸艾司氯胺酮对机器人辅助腹腔镜下根治性前列腺切除术患者的影响 [21] 脑电双频指数指导下丙泊酚闭环靶控输注麻醉在经口腔前庭入路机器人辅助甲状腺切除术中的应用 [22] Mako 骨科手术机器人辅助人工全膝关节置换术的配合 [23] 机器人辅助骨科手术后深静脉血栓形成的影响因素及风险预警管理研究 [24] 机器人辅助椎弓根螺钉内固定术对无神经损伤胸腰椎骨折患者临床疗效的影响因素分析 [25] 疼痛管理联合积极心理干预在机器人导航辅助创伤性骨折治疗术患者中的应用效果 [26] 不同模式下骨科手术机器人微创经椎间孔入路腰椎椎间融合术的置钉准确性与手术效率比较 [27] 机器人辅助后交叉韧带重建术治疗后交叉韧带损伤的临床疗效研究 [28] 手术机器人联合 O 臂导航系统微创治疗对髋关节置换术患者出院准备度的影响 [29] 个性化冠状位对线全膝关节置换术临床疗效的 Meta 分析
印象笔记
有道云笔记
微博
QQ空间
微信
二维码
意见反馈