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机器人辅助腹腔镜与传统腹腔镜行结直肠癌手术的 安全性和有效性比较

关键词： 结直肠癌；腹腔镜；机器人；安全性；有效性

李书原，楼征，张卫   

  • Vol. 2 No. 4 Aug. 2021
  • DIO:10.12180/j.issn.2096-7721.2021.04.006 发布日期:2022-01-21 阅读数:411
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  • 作者简介:

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结直肠癌是最常见的消化道恶性肿瘤之一，严重威胁着患者的身体健康。外科手术是治疗结直肠癌的有效方法。目前，微创手术因创伤小、恢复快等优点，成为许多患者的首选。传统腹腔镜手术在技术上存在一定的难度，它需要外科医生拥有丰富的腹腔镜操作经验。而达芬奇机器人拥有高清的 3D 镜头、灵活的机械臂以及更符合人体工程学的操作方式，在设计上优于腹腔镜。但多项研究结果显示，机器人结直肠手术的围手术期结果、远期结果与传统腹腔镜相比未见明显优势，而费用却明显增加。目前，机器人结直肠手术已被证实是安全可行的，其便于进行体内肠吻合，并可以缩短学习曲线。达芬奇机器人可在术空间狭小、解剖复杂的盆腔内操作。在面对内脏肥胖、骨盆狭窄、低位肿瘤等病例时，它的视觉系统也有助于辨识解剖层次，更好的保留盆腔自主神经，可能会促进泌尿与性功能的术后恢复。随着各领域的新技术不断发展和融合，以及外科医生机器人手术经验的积累，相信机器人手术在未来会拥有更广阔的应用前景。

Colorectal cancer is one of the most common digestive tract malignancies, which is a severe threat to human health. Surgery is an effective treatment for colorectal cancer. At present, minimally invasive surgery has become the first choice  of many patients since its advantages of minor injury and quick recovery. Laparoscopic surgery is technically difficult, which requires rich experience of surgeons. The Da Vinci robot-assisted surgical system is equipped with high-definition 3D view, flexible robotic arm and good ergonomics, which is superior to laparoscopy. According to latest studies, the perioperative results and long-term results of robot-assisted colorectal surgery showed no obvious advantages over traditional laparoscopy, but the cost is significantly increased. However, robotic colorectal surgery is safe and feasible to perform intestinal anastomosis, which also has a shorter learning curve. Robotic surgery is more suitable for pelvic operation, which has narrow surgical space and complex anatomy. When dealing with visceral obesity, male pelvis and low tumor location, the visual system of robotic surgery system can identify the anatomical level, which may help to preserve pelvic autonomic nerve better during operation and accelerate the recovery of urinary and sexual function after surgery. With the continuous combination of new technologies in various fields and the accumulation of robotic surgery experience for surgeons, it is believed that the robotic surgery will be widely used in the near future.