2023版機(jī)器人輔助胰腺手術(shù)國(guó)際共識(shí)指南解讀

【關(guān)鍵詞】胰腺手術(shù)；機(jī)器人；共識(shí)指南；胰管修復(fù)modularpancreatosplenectomy,RAMPS)等]中應(yīng)用機(jī)器人輔助手術(shù)系統(tǒng)。在國(guó)內(nèi)外知名外科專家，制定了2023版國(guó)際共識(shí)指南[2]。2023版指南圍繞機(jī)RD聯(lián)合血管切除術(shù)和RPD聯(lián)合血管切除術(shù)在30d發(fā)病率、90d病死率和3年生存率方面亦無(wú)差異[8]。術(shù)的效果不劣于改良Blumgart吻合術(shù)。孟堯等[11]報(bào)告了行“HO”半荷包捆體生存期與LDP相當(dāng)[16]。2023版指南指出，需要20例RDP度過基于手術(shù)時(shí)結(jié)清掃不徹底，患者的5年生存率低[17]。2003年Strasberg等[18]提出[19]。2022年本團(tuán)隊(duì)報(bào)告了1例單孔機(jī)器人輔助胰腺部分切除術(shù)[20],之后又質(zhì)量[23]。損胰管進(jìn)行修復(fù)，保留了胰腺的外分泌功能[24]。2023版指南中對(duì)胰管修復(fù)(一)主胰管修復(fù)術(shù)RCP)放置胰管支架治療胰管破裂導(dǎo)致的胰瘺，而Giuliani等[26]與Misawa(二)胰腺端端吻合術(shù)新發(fā)糖尿病發(fā)生率及術(shù)后胰瘺發(fā)生率無(wú)差異[28]。2023版指南認(rèn)為，醫(yī)師需時(shí)間[22,24]。sstatementonroboticpancreaticsurgery[J].HepatobiliarySurgNutr, 2019,8(4):345-360.DOI:10.21037/hbsn.2019.07.08.guidelinesonroboticpancreaticsurgeryin20gNutr,2024,13(1):89-104.DOI:10.21037/hbsn-23-132.ofroboticcomparedtoopenpancreaticoduodenectomyafterneoadjuvantchemotherapyforpan8-2254.DOI:10.1007/s0[4]ZhangXP,XuS,ZhaoZM,etal.Outcoscopicpancreatoduodenectomyfollowinglearningcurvesofsurgeons:amulticenterstudyon2255patients[JDOI:10.1097/SLA.0000000000006167.[publishedonlineaheadofprintDecember11,2023].https://journals.lwact/9900/outcomes_of_robotic_versus_lapar15141-15148.DOI:10.1icoduodenectomyinelderlypatients:apropensysis[J].HPB(0xford),2023,25(3):301-310.DOI:10.1016/j.hpb.2022.11.[7]KauffmannEF,NapoliN,MenonnaF,etal.Roboticpancreatoectomywithvascularresecti(8):1111-1122.DOI:10.1007/s00423-016-1499-8.enectomywithvascularresectionforpancrcksArchSurg,2022,407(4):1489-1491125-1130.DOI:10.12290/xhy12180/j.issn.2096-772軍醫(yī)學(xué)院學(xué)報(bào)，2022,43(11):1109-1112[14]RodriguezM,MemeoR,Leonrgery?[J].HepatobiliarySurgNutr,2018,7(5):345-352.DOI:10.21037/hbsn.2018.09.03.alpancreatectomyforpancreaticductaladenocarcinoma:a3389/fonc.2021.752236. distalpancreatectomyforleft-sidedpancreaticrgeon′sexperienceof228consecutivecases[J].SurgEndosc,2020,34(6):2465-2473.DOI:10.1007/s00464-019-07047-8. cinoma[J].AnnSurgOncol,2022,29(1):366-375.ncreatosplenectomy[J].Surgery,2003,133(5):521-527.DOI:10[19]LiuQ,ZhaoG,ZhaoZ,etal.Theradicalantegrademodularpancreatosplenectomyusingtheproach[J].LangenbecksArchSurg,2021,-portrobot-assisIntelligentSurgery,2022,5(1):32-35.DOI:10.1016/j.isurg.2022.0[21]SongKB,KimSC,ParkKM,etal.Lapartomyforbenignorlow-grademalignantlesionsinthepakandproximalbody[J].SurgEndosc,2015,29(4):937-946.DOI:10.1007/s00464-014-3756-7.[23]BassiC,MarchegianiG,ivepancreaticfistula:11years-591.DOI:10.1016/j.surg.2016.11.014.[25]MaireF,PonsotP,DeboveC,etal.Endoaticfistulaafterenucleationofpancreatictumors[J].SurgEndosc,2015,29(11):3112-3116.DOI:10.1007/s00464-014-4034-4.[26]GiulianiT,MarchegianiG,GirgisMD,etal.Endtofpancreaticstentfor“deep”pancreaticenucleationsoperativetechniqueandprelimiSurgEndosc,2020,34(6):2796-2802.DOI:10.1007/s00464-020-0750[27]MisawaT,ImazuH,FujiwaraY,etal.Efficacyofnasopancreaticstentingpriortolaparoscopicenucleationofpancreaticinetumor[J].AsianJEndoscSu/ases.12006.[28]HuynhF,Cruz