Comparative Study On The Treatment Of Hilar Cholangilarcinoma By Da Vinci Robotic Surgical System And Traditional Open Surgery

ObjectiveSummarize the clinical experience of Hilar cholangicarcinoma surgicaltherapy by Da Vinci Robotic Surgical System, to find the method that Help toimprove the operation.MethodsRetrospective analysis the clinical data of Hilar cholangicarci-nomain patientswho experienced treatment by Da Vinci Robotic Surgical System and open surgery inliver area A leonardo of the second artillery force liberation army general hospitaltreating gastrointe-stinal disease, from January2009to November2011.the patientsare divided into robot group51cases and the open surgery group40cases. Theanalysis of the operation process, t test perioperative management, postoperativerecovery, and the survival condition, etc.ResultsThe cumulative survival rate of51cases of robotic surgery patients and40cases of open surgery patients were no significant differences (P>0.05图4),Theresults of the liver bile duct carcinoma according to door Bismuth-en-Corlette pointstype: robot group of type I7cases, Ⅱ type13cases, IlI type a10cases, Ⅲ type b9cases and Ⅳtype12patients. Open group4cases of type I, Ⅱtype10cases, IlI type a,type b7cases Ⅲ8cases and Ⅳtype (11). Which I type II two of cumulative survivalrate is not statistically significant difference (P>0.05). III、IV two of cumulativesurvival rate is statistically significant difference (P <0.05). Robot high differentiatedadenocarcinoma of11cases, different-iated adenocarcinoma in12cases, lowdifferentiated adenocarcinoma (19cases), tubular or papillary carcinoma in3, mucousadenocarcinoma in3, biliary cystadenocarcinoma adenocarcinoma in1and2casesother cancer types; Open group high differentiated adenocarcinoma in8cases, differ-entiated adenocarcinoma in9cases, low differentiated adenocarcinoma in15cases, tubular or papillary carcinoma in5patients, and slime aden-ocarcinoma in2cases,biliary cystadenocarcinoma adenocarcinoma0cases and other cancer types in1. Highdifferentiated adenocarcinoma two of cumulative survival rate comparing statisticalsignificance (P>0.05). In two differentiated adenocarcinoma of cumulative survivalrate is not statistically significant difference (P>0.05). Low differentiatedadenocarcinoma two of cumulative survival rate is not statistically significantdifference (P>0.05). Tubular mucous biliary cystaden-ocarcinoma adenocarcinomatwo of cumulative survival rate is not stat-istically significant difference (P>0.05).Robot group R0(radical) resection26cases, the resection rate for26/51, R1, R2(palliative) resection for12,11cases respectively, R1, R2(palliative) removal rate for23/51, and another2cases not pathological examination, and the specific situation isremoved. In the open group R0(radical) resection25cases, the resection rate for25/40, R1, R2(palliative) resection for8, respectively in6, R1, R2(palliative)removal rate is14/40. There is another1cases not pathological examination, and thespecific situation is removed, two groups of R0resection cumulative survival rate isstatistically significant difference (P <0.05). R1、R2resection cumulative survivalrate is not statistically significant difference (P>0.05). According to TNM stagingclinical T, in patients with T1period of robot,9cases of open in6, two groups ofpatients who underwent surgical cumulative survival rate is statistically significantdifference (P <0.05). T2stage cancer of the robot in8cases,10cases of open group,two groups of patients who underwent surgical cumulative survival rate is statisticallysignificant difference (P <0.05). T3group in patients with19cases with robots, opengroup in13, two groups of patients who underwent surgical cumulative survival rateis not statistically significant difference (P>0.05). T4in15cases of patients withrobots, open group11cases, two groups of patients who underwent surgicalcumulative survival rate is not statistically significant difference (P>0.05). Morethan70-year-old two groups of patients who underwent surgical cumulative survivalrate is statistically significant difference (P <0.05).70-year-old two groups ofpatients who underwent surgical cumulative survival rate is not statistically sig-nificant difference (P>0.05). Robot group and the open group two groups weremedian age interval comparing statistical significance (P <0.05). In the two groups ofliver and blood coagulation situation in contrast, serum total bilirubin, andpostoperative recovery compared the Alt (P>0.05) was not statistically significant.Serum albumin, PT, APTT pre-operative the two groups of comparisons have a difference (P <0.05).Conclusion1. The robot assistant system have the slightly longer postoper-ative mediansurvival time in those who experienced R0resection,the early stages of the tumor,Bismuth Ⅲ and Ⅳ type of Hilar cholangicarcinoma and elderly patients than thetraditional open operation.2. The robot assistant system to broaden the traditional open surgeryindications, such as the elderly patients, with more basic diseases acute or chronicdisease patients whose body overdrawed.3. The robot assistant operation system have less dependence for capacityliquid than open surgery, have adervance in maintain the ele-ctricity and waterbalance, the Hemolysis blood coagulation balance, reduce complications, showparticularly advantage in the emergency department patients.4. Both lots of home and abroad robot minimally invasive surgery testsprove that whose safety and efficacy will expand and further the field of existingminimally invasive surgery, some never before further surgery, such as Ⅲ type ofHilar cholangicarcinoma, or even higher points need fine operation, even theselectivity of lymph node clean will come ture.