机器人复杂直肠癌手术探索与思考

Exploration and reflection on robotic complex rectal cancer surgery

摘要:

复杂直肠癌常需实施超越全直肠系膜切除范围的联合脏器切除，或进行扩大范围的侧方淋巴结清扫（LLND）。受制于病灶位置深在、盆腔空间狭小及局部解剖复杂等因素，传统开放及腹腔镜手术常存在视野受限、操作困难及手术风险较高等问题。随着机器人辅助手术技术的发展，其高清三维视野、高自由度机械臂及符合人体工程学的设计，克服了传统腹腔镜器械之间干扰及狭窄盆腔操作受限等缺点，使手术操作更加精细、安全。近年来，机器人技术在LLND及盆腔多脏器联合切除等复杂直肠癌手术中已显示出明显优势。本文结合国内外相关研究及笔者的临床实践经验，对机器人辅助手术在复杂直肠癌治疗中的可行性及其优劣势进行探讨。

Abstract:

Complex rectal cancer often requires extended multivisceral resection beyond the total mesorectal excision plane or lateral lymph node dissection (LLND) beyond the conventional range. Owing to the deep pelvic location, limited operating space, and complex local anatomy, conventional open or laparoscopic surgery is associated with restricted visualization, technical difficulty, and increased surgical risk. With the advancement of robot-assisted surgical technology, its high-definition three-dimensional vision, articulated robotic arms with multiple degrees of freedom, and ergonomic improvements effectively overcome the limitations of traditional laparoscopy, allowing precise manipulation in narrow pelvic spaces. These advantages have made robotic surgery increasingly valuable in complex rectal cancer procedures such as LLND and multivisceral resection. This review summarizes recent literature and the authors' clinical experience to discuss the feasibility, advantages, and limitations of robotic-assisted rectal cancer surgery.