目的：探讨达芬奇机器人手术行妇科手术的安全性、可行性及临床应用价值。方法：回顾性分析吉 林省肿瘤医院于 2014 年 10 月 ~2019 年 7 月完成的达芬奇机器人妇科手术患者 286 例的临床资料，其中恶性肿瘤 183 例，良性手术 103 例。恶性肿瘤中，99 例宫颈癌，82 例子宫内膜癌，1 例卵巢癌，1 例阴道癌。评估所有患者 的临床指标，包括手术时间、术中失血量、术后肠道功能恢复时间、膀胱功能恢复时间、腹部切口愈合时间；分析 恶性肿瘤患者的淋巴结切除数目、术后并发症发生情况（出血、感染、尿潴留、肠梗阻、下肢深静脉血栓等）、总 住院时间等；通过检测所有手术患者血清 C 反应蛋白（CRP）和白介素 -6（IL-6）浓度的变化判断手术对机体炎 症反应的影响。结果：286 例患者手术均顺利完成，无中转开腹，无术中大出血、脏器损伤等严重并发症。手术时 间 34~280min，平均（148.7±97.8）min；出血量 0~170ml，平均（83±69）ml；术后肠道功能恢复时间为 6~68h， 平均（35.3±19.6）h；膀胱功能恢复时间 10~504h；术后 72h 引流量 9~376ml，平均（198.3±79.4）ml；引流管留 置时间 49~296h，平均（187.9±74.8）h；术后腹部切口拆线 78~128h，平均（96.3±10.6）h；恶性肿瘤切除淋巴结 切除数目 7~46 枚，平均（33.4±7.3）枚；住院时间 85~678h，平均（304.5±107.3）h。术后感染发生 6 例，肠梗阻 5 例，血栓性并发症 4 例，1 例单侧小腿肌间静脉血栓，1 例左侧腘静脉血栓，1 例 PICC 置管处头静脉血栓性静脉 炎，1 例术后 5 个月（放化疗）出现右小腿肌间静脉血栓，经溶栓、抗凝治疗好转；术后发生淋巴囊肿 24 例，其中 14 例出现不同程度的外阴水肿，经对症处置后均恢复良好。于术后 24h 测定 C 反应蛋白浓度为 39.8~220.3mg/L，平 均（109.47±38.79）mg/L；术后 5d 浓度为 4.7~21.4mg/L，平均（19.58±5.63）mg/L。术后 24h 测定白介素 -6 浓度为 10.2~18.9ng/L，平均（14.57±3.94）ng/L；术后 5d 浓度为 3.7~12.4ng/L，平均（6.51±2.74）ng/L。结论：达芬奇机器 人应用于妇科手术安全可行，值得临床推广应用。
Objective: To investigate the safety, feasibility and clinical application value of Da Vinci surgical system in gynecological surgery. Methods: The clinical data of 286 patients underwent Da Vinci robotic surgery in Jilin Province Cancer Hospital from October 2014 to July 2019 was retrospectively analyzed. Results: All the surgeries were successfully completed without conversion to open surgery, no massive hemorrhage or organ damage was found. The operation time was 34min to 280min, the mean operation time was (148.7±97.8) min. The bleeding volume was 0 ml to 170ml, with mean bleeding volume of (83±69) ml. The recovery time of intestinal function after surgery was 6h to 68h, with average recovery time of (35.3±19.6) h. The recovery time of bladder function was 10h to 504h. The volume of drainage was 9ml to 376ml 72 hours after surgery, with average volume of (198.3± 79.4) ml. The drainage tube indwelling time was 49h to 296h, with mean time of (187.9±74.8) h. Stitch removing time of abdominal incision was 78h to 128h, with an average time of (96.3±10.6) h. The number of lymph node resections for malignant tumor resection was 7 to 46, with an average of (33.4±7.3). Hospital stay was 85h to 678h, with an average of (304.5±107.3) h. 6 cases of postoperative infection, 5 cases of intestinal obstruction, 4 cases of thrombotic complications, 1 case of unilateral calf intermuscular venous thrombosis, 1 case of left iliac vein thrombosis, and 1 case of venous thrombosis of PICC catheter were found. 1 case of thrombophlebitis caused by PICC tube dwelling. 1 cases of venous thrombosis on the right calf muscle 5 months after chemoradiotherapy, which improved after thrombolysis and anticoagulation. 24 cases of postoperative lymphadenopathy were found, among which 14 cases of vulval edema in different degrees happened and all recovered well after symptomatic treatment. In the above cases, the C-reactive protein concentration was measured at 39.8mg/L to 220.3mg/L 24 hours after surgery, with an average of (109.47±38.79) mg/L. The concentration was 4.7mg/L to 21.4mg/L 5 days after surgery, with an average of (19.58±5.63) mg/L. The concentration of interleukin-6 was determined to be 10.2ng/L to 18.9ng/L 24 hours after surgery, with an average of (14.57±3.94) ng/L. The concentration was 3.7ng/L to 12.4ng/L 5 days after operation, with an average of (6.51±2.74) ng/L. Conclusion: Da Vinci surgical system is safe and feasible for gynecological surgery, which is worthy to be promoted for clinical application.