高精准达芬奇手术机器人在复杂及特殊部位 肝切除中的临床应用评价

Evaluation of the Clinical Application of the High-Precision Da Vinci Surgical System in Hepatectomy for Complex and Special Liver Segments

摘要: 随着“精准外科”理念的深入人心和微创技术的迭代升级，达芬奇机器人手术系统(Da Vinci Surgical System)已从早期的探索性应用逐步走向成熟，成为肝脏外科领域处理复杂病例的重要利器。相比于传统腹腔镜技术，达芬奇机器人凭借其裸眼3D高清视野、EndoWrist仿真手腕的灵活操作以及独特的震颤过滤技术，有效突破了腹腔镜在深部狭窄空间操作的局限。本文系统回顾了近期国内外的多中心大样本研究、荟萃分析及专家共识，深入剖析了达芬奇机器人(涵盖Xi及SP系统)在大范围肝切除、特殊困难部位(如右后叶、尾状叶、中央区)切除、巨大肝肿瘤处理以及恶性肿瘤(如肝细胞癌、结直肠癌肝转移)根治中的应用现状、技术优势及肿瘤学获益。研究表明，机器人手术在减少术中出血、降低中转开腹率、提高R0切除率及改善长期生存预后方面具有显著优势。此外，文章还从卫生经济学评价、模拟培训体系构建、手术团队协作模式及围术期加速康复等维度进行了全面探讨，并对单孔机器人等前沿技术的发展前景进行了展望，旨在为临床外科医生提供参考。

Abstract: With the concept of “precision surgery” deeply rooted in people’s hearts and the iterative upgrade of minimally invasive technology, the Da Vinci Surgical System has gradually matured from the early exploratory application, and has become an important weapon in the field of liver surgery to deal with complex cases. Compared with the traditional laparoscopic technology, Da Vinci robot effectively breaks through the limitations of laparoscopic operation in deep narrow space by virtue of its naked-eye 3D high-definition vision, flexible operation of EndoWrist simulated wrist and unique tremor filtering technology. This paper systematically reviews the recent multi-center and large-sample research, meta-analysis and expert consensus at home and abroad, and deeply analyzes the application status, technical advantages and oncology benefits of Da Vinci robot (covering Xi and SP systems) in large-scale liver resection, resection of special difficult parts (such as right posterior lobe, caudate lobe and central area), treatment of huge liver tumors and radical treatment of malignant tumors (such as hepatocellular carcinoma and liver metastasis of colorectal cancer). Research shows that robotic surgery has significant advantages in reducing intraoperative bleeding, reducing the rate of conversion to laparotomy, increasing the rate of R0 resection and improving the long-term survival prognosis. In addition, the article also makes a comprehensive discussion from the dimensions of health economics evaluation, simulation training system construction, operation team cooperation mode and perioperative accelerated rehabilitation, and looks forward to the development prospect of cutting-edge technologies such as single-hole robot, so as to provide reference for clinical surgeons.