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机器人结直肠手术的局限与前景

关键词： 结直肠手术；机器人；腹腔镜

连国栋，李乐平，靖昌庆   

  • 1 No. 4 Oct. 2020
  • DIO:10.12180/j.issn.2096-7721.2020.04.009 发布日期:2020-10-29 阅读数:780
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  • 作者简介:

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微创手术目前已被大多数结直肠外科医生所认可，但腹腔镜手术存在其固有的局限性，包括立体视 觉缺失、镜头不稳定、人体工程学设计不良、器械僵硬以及操作震颤等。目前，机器人外科手术系统提供了解决方案， 包括稳定的 3-D 视野、灵活的腕式器械、良好的人体工程学设计以及震颤过滤功能。机器人辅助结直肠手术的可行 性、安全性和临床有效性都已得到了广泛验证。机器人手术在肿瘤学上是安全的，其结局可与常规腹腔镜手术相媲美， 甚至在直肠癌手术中具有更多的益处，其在狭窄骨盆中操作更方便、吻合口漏发生率低、环周切缘阳性率低、术后 肠道功能恢复快，且自主神经功能保持更完好。虽然机器人手术增加了手术时间和住院费用，但相较于其潜在的优势， 可以预见在不久的将来，机器人手术系统将成为结直肠常规手术实践的重要组成部分。

Minimally invasive surgery is currently accepted by most colorectal surgeons, but laparoscopic surgery has its intrinsic limitations, such as poor stereoscopic vision, unstable assistant-dependent camera, poor deign of ergonomics, rigid instruments and enhanced tremor during operation. Robotic surgery systems were designed to overcome the limitations of laparoscopic surgery by providing stable 3-D field views from a surgeon-controlled camera, angulated instruments with 7 degrees of freedom, markedly improved ergonomics and tremor filtering system. The feasibility, safety, and clinical effectiveness of robotassisted colorectal surgery have been widely confirmed. Outcomes of robotic surgery is comparable to conventional laparoscopic surgery and even better in rectal cancer surgery, such as more convenient operation in narrow pelvis, lower incidence of anastomotic leak, lower positive rate of circumferential resection margin, faster recovery of intestinal function after surgery and better perseveration of autonomic nerve function. Although operation time and hospitalization costs increased, considering its potential advantages, it is foreseeable that robot-assisted surgery will play an important role in routine colorectal surgery in the near future.