机器人手术系统联合血管切除重建行胰十二指肠切除术的17例疗效评价（附手术视频）

  目的  探讨机器人手术系统下联合血管切除重建行胰十二指肠切除术治疗进展期胰腺癌的临床疗效。  方法  回顾性分析自2011年8月?2018年9月上海交通大学医学院附属瑞金医院完成的17例机器人手术系统下联合血管切除重建（操作见视频1）行胰十二指肠切除术的局部进展期的胰腺癌患者的临床资料。  结果  17例患者中4例胰腺癌患者由于肿瘤侵犯严重、胰腺质地软中转开腹，13例患者手术顺利完成。16例（94%）患者手术达到R0切除。14例联合静脉重建，3例联合动脉重建。平均手术时间（401±170） min，平均术中出血（647±345） mL，术后平均住院天数（20±8） d，无围手术期死亡。术后病理及随访结果:1例为胰腺导管内乳头状黏液肿瘤，1例为胰腺神经内分泌肿瘤（G1级），目前情况良好，8例胰腺导管腺癌及1例胰腺神经内分泌癌患者于随访期间因肿瘤复发转移死亡，中位（最小值～最大值）生存期12（8～26）个月。5例胰腺导管腺癌及1例恶性胰腺导管内乳头状黏液肿瘤患者目前继续随访中，其中1例已存活了38个月（截止至2019年7月）。  结论  机器人手术系统下联合血管切除重建行胰十二指肠切除术难度较大，但安全可行，局部进展期的胰腺癌患者经谨慎评估患者病情和医院手术能力后可以采用。

The Efficacy of 17 Cases of Pancreaticoduodenectomy Combined with Vascular Resection and Reconstruction by Using Robotic Operation System (with Video)

  Objective  To explore the clinical efficacy of pancreaticoduodenectomy (PD) combined with vascular resection and reconstruction under robotic surgery system in the treatment of borderline resectable pancreatic cancer.  Methods   The clinical data of 17 patients with borderline resectable pancreatic cancer who underwent PD combined with vascular resection and reconstruction (see the Video 1 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760202) under robotic surgery system between August 2011 and September 2018 was analyzed retrospectively.  Results  There were 4 cases required conversion because of serious tumor invasion and soft pancreas texture, the other 13 cases were successfully completed. 16 cases (94%) achieved margin-negative resection (R0 resection), 14 cases combined with vein resection, and 3 cases combined with arterial resection. The mean operation time was (401±170) min, the mean blood loss was (647±345) mL, the mean postoperative length of hospital stay was (20±8) d. There was no perioperative death. Postoperative pathology findings and follow-up outcomes were as follows: 1 patient was diagnosed as intraductal papillary mucinous neoplasm (IPMN) and 1 patient was diagnosed as pancreatic neuroendocrine tumors (PNET) (Grade 1), 8 patients with pancreatic ductal adenocarcinoma (PDAC). 1 patient with pancreatic neuroendocrine carcinoma (PNEC) died because of tumor recurrence and metastasis during the follow-up period, the median (Min-Max) survival time was 12 (8-26) months. 5 patients with PDAC and 1 patient with malignant IPMN were currently in the follow-up period.  Conclusion  It is safe and feasible to perform RPD with vascular resection and reconstruction. The patient's condition should be fully evaluated before surgery to select the most appropriate treatment.