关键词： 机器人手术；胰十二指肠切除术；胰肠吻合；胰瘘；半荷包缝合
孟尧，朱中飞，胡昊，经纬，郑楷炼，马静雯，何天霖
目的：总结机器人辅助下“HO”半荷包捆绑借力胰十二指肠切除术的经验及应用体会。方法：回顾性分析 2015 年 3 月 11 日 ~2020 年 10 月 24 日在我院接受机器人辅助胰十二指肠切除术行“HO”半荷包捆绑借力胰肠吻合12 例患者的临床资料，对术中及术后相关情况进行分析。结果：11 例患者顺利完成手术，中转开腹 1 例，手术时间（322±64）min，胰肠吻合时间（19.7±8.7）min，术中出血（202±64）ml。术后 3 例出现并发症，其中胰瘘 2 例（均为生化瘘），胃排空障碍 1 例，消化道应激性溃疡、急性胃潴留 1 例，除应激性溃疡患者开腹探查，行胃造瘘、胆肠胰肠之间造瘘、胰管外引流外，余患者经胃肠减压、抑制胰酶、延长腹腔引流时间及营养支持处理后康复出院。术后住院时长为（12±7）d，术后 90d 死亡 0 例。结论：机器人辅助下“HO”半荷包捆绑借力的胰空肠吻合术操作简便，利于快速掌握；胰肠吻合紧密牢靠，愈合快，适用范围广，对减少术后胰瘘等并发症有明显优势。
Objective: To introduce the experience of robot-assisted pancreaticoduodenectomy with“HO”half-purse binding for pancreaticojejunostomy(PJ). Methods: The clinical data of 12 patients who underwent robot-assisted pancreaticoduodenectomy with“HO”half-purse binding for PJ from March 11, 2015 to October 24, 2020 were analyzed retrospectively. Results: The operations were successfully completed for 11 patients and 1 patient was converted to open operation. The average operation time was (322±64) min, PJ duration was (19.7±8.7) min and the average intraoperative bleeding was (202±64) ml. Postoperative complications occurred in 3 cases, including pancreatic fistula (n=2, grade A), gastric emptying disturbance (n=1) and stress ulcer of digestive tract and acute gastric retention (n=1). Except for the patients with gastrointestinal bleeding who underwent laparotomy, gastroenterostomy and external drainage of pancreatic duct, other patients were discharged from hospital after gastrointestinal decompression, trypsin inhibition, prolongation of abdominal drainage time and nutrition support. The average postoperative hospital stay was (12±7) days, and 0 cases died 90 days after surgery. Conclusion: The robot-assisted pancreaticoduodenectomy with“HO”half-purse binding for PJ is easy to learn and perform, which has obvious advantages in reducing postoperative complications such as pancreatic fistula because of its reliable anastomosis and fast recovery after surgery.