机器人系统在早期卵巢癌全面分期手术中的应用进展

doi:10.12280/gjfckx.20210698

摘要/Abstract

摘要：

早期卵巢癌以手术治疗为主,早期诊断、规范化的治疗可显著提高患者的5年生存率。机器人辅助腹腔镜手术打破了传统腹腔镜手术的局限,具有3D立体视野、高清及稳定的镜头、7个具有自由度的灵活内腕和改进的人体工程学特点,能够在深而窄的手术空间进行精细操作,并具有术中出血量少、术后并发症少和恢复快等优势,在复杂手术中的效果优于传统腹腔镜手术。近年来关于机器人辅助腹腔镜在早期卵巢癌的全面分期手术中的应用研究逐渐增多,微创手术的发展尤其是机器人手术系统的应用为早期卵巢癌的治疗提供了新的方向,选择合适的手术方式对于治疗早期卵巢癌有重要意义。综述机器人系统应用于早期卵巢癌手术的充分性、可行性及安全性。

关键词: 机器人手术, 腹腔镜检查, 卵巢肿瘤, 肿瘤分期, 存活率, 淋巴结切除术

Abstract:

Surgery is the main treatment for early ovarian cancer. Early diagnosis and standardized treatment can significantly prolong the 5-year survival rate of patients. Robot-assisted laparoscopic surgery breaks the limitations of traditional laparoscopic surgery, it has 3D stereoscopic vision, high-definition and stable lens, flexible inner wrist with 7 degrees of freedom, and improved ergonomics. It can perform fine operations in deep and narrow operating spaces and it also has the advantages of less intraoperative bleeding, less postoperative complications and faster recovery. So it has excellent results in complex operations compared with traditional laparoscopic surgery. In recent years, the research on robot-assisted laparoscopy in the comprehensive staging of early ovarian cancer has gradually increased, the development of minimally invasive surgery, especially the application of robotic surgery systems, provides a new direction for the treatment of early ovarian cancer, choosing an appropriate surgical method is of great significance for the treatment of early ovarian cancer. This article mainly reviews the adequacy, feasibility and safety of robotic systems in early ovarian cancer surgery.

Key words: Robotic surgical procedures, Laparoscopy, Ovarian neoplasms, Neoplasm staging, Survival rate, Lymph node excision

付小雨, 郭瑞霞. 机器人系统在早期卵巢癌全面分期手术中的应用进展[J]. 国际妇产科学杂志, 2022, 49(3): 282-285.

FU Xiao-yu, GUO Rui-xia. Advances of Robotic Systems in Comprehensive Staging Surgery for Early Ovarian Cancer[J]. Journal of International Obstetrics and Gynecology, 2022, 49(3): 282-285.

参考文献 24

[1]	Armstrong DK, Alvarez RD, Bakkum-Gamez JN, et al. Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2021, 19(2):191-226. doi: 10.6004/jnccn.2021.0007. doi: 10.6004/jnccn.2021.0007
[2]	Heitz F, Harter P, du Bois A. Staging laparoscopy for the management of early-stage ovarian cancer: a metaanalysis[J]. Am J Obstet Gynecol, 2013, 209(6):592-593. doi: 10.1016/j.ajog.2013.06.035. doi: 10.1016/j.ajog.2013.06.035
[3]	Knisely A, Gamble CR, St Clair CM, et al. The Role of Minimally Invasive Surgery in the Care of Women with Ovarian Cancer: A Systematic Review and Meta-analysis[J]. J Minim Invasive Gynecol, 2021, 28(3):537-543. doi: 10.1016/j.jmig.2020.11.007. doi: 10.1016/j.jmig.2020.11.007
[4]	熊维, 曹莉莉, 蒋路频, 等. 早期卵巢上皮性癌经腹腔镜与开腹行全面分期手术的临床对比分析[J]. 中华妇产科杂志, 2017, 52(2):103-109. doi: 10.3760/cma.j.issn.0529-567x.2017.02.007. doi: 10.3760/cma.j.issn.0529-567x.2017.02.007
[5]	Tantitamit T, Lee CL. Is It the Time for Laparoscopic Management of Early-stage Ovarian Malignancies?[J]. Gynecol Minim Invasive Ther, 2018, 7(3):93-103. doi: 10.4103/GMIT.GMIT_59_18. doi: 10.4103/GMIT.GMIT_59_18 pmid: 30254949
[6]	Minig L, Saadi J, Patrono MG, et al. Laparoscopic surgical staging in women with early stage epithelial ovarian cancer performed by recently certified gynecologic oncologists[J]. Eur J Obstet Gynecol Reprod Biol, 2016, 201:94-100. doi: 10.1016/j.ejogrb.2016.03.029. doi: 10.1016/j.ejogrb.2016.03.029
[7]	Merlier M, Kerbage Y, Pierache A, et al. Impact on Prognosis of the Surgical Route, Laparoscopy or Laparotomy, for the Surgical Staging of Early Stage Ovarian Cancer-A Study from the FRANCOGYN Group[J]. J Clin Med, 2020, 9(11):3528. doi: 10.3390/jcm9113528. doi: 10.3390/jcm9113528
[8]	Brown JV 3rd, Mendivil AA, Abaid LN, et al. The safety and feasibility of robotic-assisted lymph node staging in early-stage ovarian cancer[J]. Int J Gynecol Cancer, 2014, 24(8):1493-1498. doi: 10.1097/IGC.0000000000000224. doi: 10.1097/IGC.0000000000000224 pmid: 25078341
[9]	Nasioudis D, Minis E, Chapman-Davis E, et al. Minimally Invasive Staging of Apparent Stage I Malignant Ovarian Germ Cell Tumors: Prevalence and Outcomes[J]. J Minim Invasive Gynecol, 2019, 26(3):471-476. doi: 10.1016/j.jmig.2018.05.021. doi: 10.1016/j.jmig.2018.05.021
[10]	纪妹, 赵曌, 李悦, 等. 非倒转体位下机器人系统辅助腹腔镜手术在早期卵巢恶性肿瘤全面分期手术中的应用[J]. 中华妇产科杂志, 2020, 55(3):183-187. doi: 10.3760/cma.j.cn112141-20191001-00531. doi: 10.3760/cma.j.cn112141-20191001-00531
[11]	Uccella S, Nero C, Vizza E, et al. Sentinel-node biopsy in early-stage ovarian cancer: preliminary results of a prospective multicentre study (SELLY)[J]. Am J Obstet Gynecol, 2019, 221(4):324.e1-324.e10. doi: 10.1016/j.ajog.2019.05.005. doi: 10.1016/j.ajog.2019.05.005
[12]	Lago V, Bello P, Montero B, et al. Sentinel lymph node technique in early-stage ovarian cancer (SENTOV): a phase II clinical trial[J]. Int J Gynecol Cancer, 2020, 30(9):1390-1396. doi: 10.1136/ijgc-2020-001289. doi: 10.1136/ijgc-2020-001289
[13]	Clair KH, Tewari KS. Robotic surgery for gynecologic cancers: indications, techniques and controversies[J]. J Obstet Gynaecol Res, 2020, 46(6):828-843. doi: 10.1111/jog.14228. doi: 10.1111/jog.14228
[14]	叶明侠, 俞凌, 范文生, 等. 机器人系统在早期卵巢癌治疗的临床应用分析[J]. 中华医学杂志, 2017, 97(13):982-985. doi: 10.3760/cma.j.issn.0376-2491.2017.13.004. doi: 10.3760/cma.j.issn.0376-2491.2017.13.004
[15]	许鹏琳, 纪妹, 赵曌, 等. 达芬奇机器人手术系统在早期卵巢癌分期手术中的应用价值研究[J]. 中国实用妇科与产科杂志, 2017, 33(10):1077-1079. doi: 10.19538/j.fk2017100122. doi: 10.19538/j.fk2017100122
[16]	Gallotta V, Cicero C, Conte C, et al. Robotic Versus Laparoscopic Staging for Early Ovarian Cancer: A Case-Matched Control Study[J]. J Minim Invasive Gynecol, 2017, 24(2):293-298. doi: 10.1016/j.jmig.2016.11.004. doi: 10.1016/j.jmig.2016.11.004
[17]	Shi C, Gao Y, Yang Y, et al. Comparison of efficacy of robotic surgery, laparoscopy, and laparotomy in the treatment of ovarian cancer: a meta-analysis[J]. World J Surg Oncol, 2019, 17(1):162. doi: 10.1186/s12957-019-1702-9. doi: 10.1186/s12957-019-1702-9
[18]	Bellia A, Vitale SG, Laganà AS, et al. Feasibility and surgical outcomes of conventional and robot-assisted laparoscopy for early-stage ovarian cancer: a retrospective, multicenter analysis[J]. Arch Gynecol Obstet, 2016, 294(3):615-622. doi: 10.1007/s00404-016-4087-9. doi: 10.1007/s00404-016-4087-9
[19]	Lim CK, Kim DY, Cho A, et al. Role of minimally invasive surgery in early ovarian cancer[J]. Gland Surg, 2021, 10(3):1252-1259. doi: 10.21037/gs-2019-ursoc-07. doi: 10.21037/gs-2019-ursoc-07
[20]	Yao G, Jin X. Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis[J]. Front Surg, 2021, 8:682348. doi: 10.3389/fsurg.2021.682348. doi: 10.3389/fsurg.2021.682348
[21]	Lee M, Kim SW, Paek J, et al. Comparisons of surgical outcomes, complications, and costs between laparotomy and laparoscopy in early-stage ovarian cancer[J]. Int J Gynecol Cancer, 2011, 21(2):251-256. doi: 10.1097/IGC.0b013e318208c71c. doi: 10.1097/IGC.0b013e318208c71c
[22]	Dioun S, Wu J, Chen L, et al. Intraoperative Rupture of the Ovarian Capsule in Early-Stage Ovarian Cancer: A Meta-analysis[J]. Obstet Gynecol, 2021, 138(2):261-271. doi: 10.1097/AOG.0000000000004455. doi: 10.1097/AOG.0000000000004455
[23]	Ndofor BT, Soliman PT, Schmeler KM, et al. Rate of port-site metastasis is uncommon in patients undergoing robotic surgery for gynecological malignancies[J]. Int J Gynecol Cancer, 2011, 21(5):936-940. doi: 10.1097/IGC.0b013e3182174609. doi: 10.1097/IGC.0b013e3182174609 pmid: 21633306
[24]	Kong Q, Wei H, Zhang J, et al. Comparison of the survival outcomes of laparoscopy versus laparotomy in treatment of early-stage ovarian cancer: a systematic review and meta-analysis[J]. J Ovarian Res, 2021, 14(1):45. doi: 10.1186/s13048-021-00793-1. doi: 10.1186/s13048-021-00793-1