机器人辅助腹腔镜手术在宫颈癌治疗中的应用

周 佳玲¹, 汤 怀鹏¹, 杨 林青¹, 徐 静*²
1、济宁医学院临床医学院
2、济宁医学院附属医院

摘要

背景:随着机器人手术系统技术的提高，机器人以其独特的优势被广泛应用于辅助临床各类疾病的手术开展。目的:通过研究机器人辅助腹腔镜手术在早期宫颈癌患者手术治疗中的应用，探讨该项技术的疗效以及安全性，为早期宫颈癌患者治疗方式选择提供依据。方法:通过检索中文数据库(中国知网、万方)以及英文数据库(PubMed、Medline)中相关临床研究、系统综述等文献资料，对机器人辅助腹腔镜手术在早期宫颈癌治疗中的应用进行系统分析和总结。结论:机器人辅助腹腔镜手术治疗早期宫颈癌术中出血量少、术后康复快，术后并发症少等方面优于传统腹腔镜手术治疗，在手术时间及术中热血管损伤、淋巴水肿等副作用还有待进一步研究，并且目前还存在机械臂力反馈方面的研究及器械研发不足，机器人系统操作繁杂等局限。

关键词

Da Vinci 机器人;腹腔镜手术;宫颈癌;妇科手术

参考

[1] Tsu V,Jerónimo J.Saving the World's women fromcervical cancer[J].New Engl J Med,2016,374(26):2509. [2] 周琦,吴小华,刘继红,等.宫颈癌诊断与治疗指南(第四版)[J].中国实用妇科与产科杂志,2018,34(06):613-622. [3] 龙梅,吴楠.腹腔镜手术治疗早期宫颈癌的优势及临床进展[J].医学综述,2014,20(14):2550-2553．[4] Ramirez PT,Frumovitz M,Pareja R ， et al.Minimallyinvasive versus abdominal radical hysterectomy for cervical cancer[J].N Engl J Med,2018,379(20):1895-1904. [5] Obermair A,Gebski V,Frumovitz M,et al.AphaseⅢrandomized clinical trial comparing laparoscopic orrobotic radical hysterectomy with abdominal radicalhysterectomy in patients with early stage cervical cancer[J].JMinim Invasive Gynecol,2008,15(5):584-588. [6] Liu Z,Li X,Tian S,et al.Superiority of robotic surgeryfor cervical cancer in comparison with traditional approaches:Asystematic review and meta-analysis.Int J Surg.2017,40:145- 154. [7] 付振华.早期宫颈癌行机器人悬吊联合经阴道封闭宫颈肿瘤广泛子宫切除术安全性及近期疗效分析[D].南昌大学,2020. [8] 付宜利,潘博.微创外科手术机器人技术研究进展[J]. 哈尔滨工业大学学报,2019,51(01):1-15. [9] Zakashansky K,Bradley WH,Chuang L,et al.Recentadvances in the surgical management of cervical cancer.MtSinai J Med.2009,76(6):567-76. [10] Zhao Y,Hang B,Xiong GW,et al.Laparoscopic RadicalHysterectomy in Early Stage Cervical Cancer:A Systematic Review and Meta-Analysis.J Laparoendosc Adv Surg Tech A. 2017,27(11):1132-1144. [11] Sundar S,Balega J,Crosbie E,et al.BGCS uterinecancer guidelines:Recommendations for practice.Eur J ObstetGynecol Reprod Biol.2017,213:71-97. [12] Concin N,Matias-Guiu X,Vergote I,et al.ESGO/ESTRO/ESP guidelines for the management ofpatients with endometrial carcinoma.Int J Gynecol Cancer 2021, 31:12e39. [13] Nitecki R,Ramirez PT,Frumovitz M,et al.SurvivalAfter Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer:A Systematic Review andMeta-analysis.JAMA Oncol.2020,6(7):1019-1027. [14] Barber EL,Gehrig PA,Clarke-Pearson DL.Venousthromboembolism in minimally invasive compared with openhysterectomy for endometrial cancer.Obstet Gynecol 2016, 128:121e126. [15] Moss EL,Morgan G,Martin AP,et al.Surgicaltrends,outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England:a retrospectivecohort study.BMJ Open 2020,10:e036222. [16] Mahdi H,Aljebori Q,Lockart D,et al.Risk of venousthromboembolism after laparoscopic surgery for gynecologic malignancy.J Minim Invasive Gynecol 2016,23:1057e1062. [17] 管秋蓉.腹腔镜手术治疗宫颈癌临床预后的影响效果观察[J].中外医学研究,2019,17(05):43-45. [18] Sert BM,Abeler VM.Robotic-assisted laparoscopicradical hysterectomy(Piver type III)with pelvic node dissection-case report.Eur J Gynaecol Oncol.2006,27(5):531-3. [19] WILSON T G.Advancement of technology and itsimpact on urologists:Release of the da Vinci Xi，a new surgical robot[J].European Urology, 2014,66(5),793-794. [20] ZHANG S S,DING T,CUI Z H,et al.Efficacy ofrobotic radical hysterectomy for cervical cancer compared withthat of open and laparoscopic surgery:A separate meta-analysis of high-quality studies[J].Medicine(Baltimore 2019, 98(4): e14171. [21] LIU Z,LI X,TIAN S,et al.Superiority of roboticsurgery for cervical cancer in comparison with traditional approaches:A systematic review and meta-analysis[J].Int J Surg, 2017.[22] Rizou N,Moris D,Pikoulis E,et al.Minimally invasivelymphadenectomy in uterine cervical cancer:A systematicreview[J].Anticancer Res,2017,37(1):335-342. [23] Iavazzo C,Papadopoulou EK,Gkegkes ID.Cost assessment of robotics in gynecologic surgery:a systematicreview.J Obstet Gynaecol Res 2014,40(11):2125–34. [24] Herling SF,Palle C,Møller AM,Thomsen T,SørensenJ.Cost-analysis of robotic-assisted laparoscopic hysterectomyversus total abdominal hysterectomy for women withendometrial cancer and atypical complex hyperplasia.Acta Obstet Gynecol Scand 2016,95(3):299–308. [25] Shazly SA,Murad MH,Dowdy SC,et al.Roboticradical hysterectomy in early stage cervical cancer:A systematicreview and meta-analysis.Gynecol Oncol.2015,138(2):457-71. [26] Jin YM,Liu SS,Chen J,Chen YN,et al.Robotic radicalhysterectomy is superior to laparoscopic radical hysterectomyand open radical hysterectomy in the treatment of cervical cancer.PLoS One.2018,13(3):e0193033.[27] Wallin E,Falconer H,Rådestad AF. Sexual, bladder, bowel and ovarian function 1 year after robot-assisted radicalhysterectomy for early-stage cervical cancer.Acta ObstetGynecol Scand.2019,98(11):1404-1412. [28] Hong DG,Park NY,Chong GO,et al.Survival benefit oflaparoscopic surgical staging-guided radiation therapy in locallyadvanced cervical cancer[J].Gynecol Oncol, 2010,21 (3):163- 168. [29] Long Y,Yao DS,Pan XW,Ou TY.Clinical efficacy andsafety of nerve-sparing radical hysterectomy for cervical cancer:a systematic review and meta-analysis.PLoS One.2014,9: e94116.