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中华胸部外科电子杂志 ›› 2019, Vol. 06 ›› Issue (01) : 46 -55. doi: 10.3877/cma.j.issn.2095-8773.2019.01.11

所属专题： 机器人专题； 机器人手术； 文献；

机器人辅助微创食管切除术·综述

机器人辅助微创食管切除术的技术要点分析
李斌1, 郭旭峰1, 张晓彬1, 杨洋1, 茅腾1, 孙益峰1, 李志刚1,†()   
  1. 1. 200030　上海交通大学附属胸科医院胸外科　上海交通大学食管疾病诊治中心
  • 收稿日期:2018-12-16 出版日期:2019-02-28
  • 通信作者: 李志刚

Technical points analysis of robot-assisted minimally invasive esophagectomy

Bin Li1, Xufeng Guo1, Xiaobing Zhang1, Yang Yang1, Teng Mao1, Yifeng Sun1, Zhigang Li1,†()   

  1. 1. Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2018-12-16 Published:2019-02-28
  • Corresponding author: Zhigang Li
  • About author:
    Corresponding author: Li Zhigang, Email:
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引用本文：

李斌, 郭旭峰, 张晓彬, 杨洋, 茅腾, 孙益峰, 李志刚. 机器人辅助微创食管切除术的技术要点分析[J]. 中华胸部外科电子杂志, 2019, 06(01): 46-55.

Bin Li, Xufeng Guo, Xiaobing Zhang, Yang Yang, Teng Mao, Yifeng Sun, Zhigang Li. Technical points analysis of robot-assisted minimally invasive esophagectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(01): 46-55.

近年来，随着达芬奇机器人技术引入食管癌外科治疗，越来越多的食管外科医师了解和认识到该技术的优势，其安全性和有效性也逐渐得到认可。机器人技术可结合传统胸腹腔镜以及开放手术完成不同手术路径的操作，机器人技术的优势也可以得到充分发挥，有些在传统技术下难以快速安全完成的操作也得以改进。该文总结了现有文献报道机器人辅助微创食管切除术(RAMIE)的经验，分析各中心在手术路径、机器人辅助方式以及食管癌治疗技术上的特点。

关键词: 食管癌, 机器人辅助食管切除术, 手术路径, 技术要点

In recent years, with the development of Da Vinci robotic technology on the surgical treatment of esophageal cancer, the advantages of this technology were accepted by more and more esophageal surgeons, and its safety and efficacy are gradually recognized. Robot technology can be combined with traditional thoracoscopic or laparoscopic surgery and open surgery to complete the operation of different surgical approach. The advantages of robot technology can also be fully utilized to reduce the difficulty of surgery, especially on upper mediastinal space which are difficult to perform quickly and safely under traditional techniques. The aim of this article was to summarize the reports on the experience of robot-assisted minimally invasive esophagectomy(RAMIE), and to analyze the characteristics of different treatments of esophageal cancer in each center on surgical path and robot-assisted mode.

Key words: Esophageal cancer, Robot-assisted minimally invasive esophagectomy, Surgical approach, Technical points
表1 机器人辅助微创食管切除术(RAMIE)手术路径及围术期短期结果
作者 时间(年) n 手术路径 总淋巴结(个) 手术时间(min) 术中出血量(ml) 住院时间(d) 肺部并发症(%) 吻合口瘘(%) 喉返神经麻痹(%)
Galvani等[8] 2008 18 TH 14 267 54 10 11 33 5
Coker等[9] 2014 23 TH 15 231 100 9 13 9 NA
Mori等[10] 2016 22 TH 30 524 385 18 0 18 4.5
Dunn等[11] 2017 100 TH 17 264 75 8 11 16 33
Hodari等[12] 2015 54 Ivor Lewis 16.2 362 74.4 12.9 11.1 6.8 NA
Wee，等[13] 2016 20 Ivor Lewis 23.2 455.5 275 8 5 0 NA
Cerfolio等[14] 2016 85 Ivor Lewis 22 360 35 11 7.1 4.3 NA
Meredith等[15] 2018 147 Ivor Lewis 20.4 415 150 9 10.9 2.7 NA
Zhang等[16] 2018 61 Ivor Lewis 19.3 315.6 189.3 10 6.6 9.8 8.2
Wang等[17] 2018 31 Ivor Lewis 17.1 387.4 110 12 6.5 6.5 NA
Sarkaria等[18] 2013 21 Mc 4例/ IL 7例 20 556 307 10 23.8 38 NA
Park等[19] 2016 62 Mc 56例/ IL 6例 37.3 490.3 462.9 NA 14.5 8.1 12.9
Okusanya等[20] 2017 25 Mc 2例/IL 23例 26 661 250 8 20 4 NA
Guerra等[21] 2018 38 Mc 14例/IL 24例 33 550 80 10 8 16 2.6
Kernstine等[22] 2007 14 Mckeown 18 NA NA NA NA 14 NA
Boone等[23] 2009 47 Mckeown 29 450 625 18 44.7 21.3 19.1
Weksler等[24] 2012 11 Mckeown 23 439 200 8.7 18.2 9.1 ?
van等[25] 2015 108 Mckeown 26 381 340 16 33 19 9
Puntambekar等[26] 2015 83 Mckeown 18.4 204.9 86.6 10.4 1.2 3.6 2.4
易俊等[27] 2015 79 Mckeown 20.6 245 75 10.2 6.3 7.6 2.5
Park等[28] 2016 114 Mckeown 43.5 419.6 208.7 16 9.6 14.9 26.3
谭子辉等[29] 2016 17 Mckeown 28 195 60 15.2 17.6 0 11.8
Chiu等[30] 2017 20 Mckeown 18.2 499.5 355.7 13 5 15 25
Somashekhar等[31] 2017 35 Mckeown 32 352 380 8 2.9 0 2.9
Chao等[32] 2018 37 Mckeown 37 NA 94.1 17.5 8.1 2.7 21.6
He等[33] 2018 27 Mckeown 20 349 118 13.8 18.5 11.1 14.8
Deng等[34] 2018 79 Mckeown 20.6 356.7 103.9 14.4 7.6 7.6 10.1
Zhang等[35] 2018 249 Mckeown 18.5 250.6 215.5 11 18.1 12.9 15.3
表2 机器人辅助食管切除术辅助技术
作者 时间 手术路径 机器人技术 机械臂数量
Galvani等[8] 2008 TH HRTH 三臂
Coker等[9] 2014 TH HRTH 三臂
Mori等[10] 2016 TH HRTH 三臂
Dunn等[11] 2017 TH HRTH 三臂
Hodari等[12] 2015 Ivor Lewis HRIL 四臂
Wee，等[13] 2016 Ivor Lewis HRIL 四臂
Cerfolio等[14] 2016 Ivor Lewis HRIL 四臂
Meredith等[15] 2018 Ivor Lewis TRIL 四臂
Zhang等[16] 2018 Ivor Lewis TRIL 四臂
Wang等[17] 2018 Ivor Lewis HRIL 四臂
Sarkaria等[18] 2013 Mck / IL TRAE 四臂
Park等[19] 2016 Mck / IL TRAE 四臂
Okusanya等[20] 2017 Mck / IL TRAE 四臂
Guerra等[21] 2018 Mck / IL TRAE 四臂
Kernstine等[22] 2007 Mckeown HRMc/TRMc 三臂
Boone等[23] 2009 Mckeown HRMc 三臂
Weksler等[24] 2012 Mckeown HRMc 四臂
van der sluis PC等[25] 2015 Mckeown HRMc/TRMc 三臂
Puntambekar等[26] 2015 Mckeown HRMc 三臂
易俊等[27] 2015 Mckeown TRMc 三臂
Park等[28] 2016 Mckeown HRMc 三臂
谭子辉等[29] 2016 Mckeown TRMc 三臂
Chiu等[30] 2017 Mckeown TRMc 三臂
Somashekhar等[31] 2017 Mckeown TRMc 三臂
Chao等[32] 2018 Mckeown HRMc 四臂
He等[33] 2018 Mckeown TRMc 三臂
Deng等[34] 2018 Mckeown TRMc 三臂
Zhang等[35] 2018 Mckeown HRMc/TRMc 三臂
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