【摘要】 目的：通过分析中山大学附属第一医院胆胰外科的实践经验，探讨机器人在Bismuth-CorletteⅢ及IV型肝门部胆管癌切除术中应用的安全性及近期疗效。方法：回顾性分析自2017年7月至2023年5月于中山大学附属第一医院胆胰外科接受机器人辅助肝门部胆管癌切除术的Bismuth-CorletteⅢ及Ⅳ型患者的临床资料，分析其相关临床特征及术后转归情况。结果：共有9例Bismuth-CorletteⅢ及Ⅳ型肝门部胆管癌患者接受机器人辅助肝门部胆管癌切除术治疗，其中Ⅲa型有4例，Ⅲb型有4例，Ⅳ型有1例；中转开腹1例；中位手术时长为645 min[四分位距（interquartile range,IQR）:554～745 min]，中位术中失血量为300 mL (IQR:150～650 m L)，淋巴结获取的中位数为11个（IQR:6～12个）；有7例（77.8%）患者获得R0切除；术后有5例（55.6%）患者出现主要并发症（Clavein-Dindo分级为Ⅲ～Ⅴ级），其中包括腹腔感染2例、肝功能衰竭2例和消化道出血1例；有1例患者术后19 d因出现空肠-空肠吻合口出血而接受再次手术，术后恢复良好；有1例患者术后30 d内死于肝功能衰竭；所有患者的中位术后住院时间为18 d(IQR:10～32 d)。结论：机器人辅助Bismuth-CorletteⅢ及Ⅳ型肝门部胆管癌根治术从技术上来讲是安全、可行的，近期疗效良好，可以在有成熟的机器人辅助肝胆胰手术经验的中心开展。更多还原

【Abstract】 Objective:To evaluate the safety and short-term efficacy of roboticassisted resection for Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangiocarcinoma in Department of Pancreatobiliary Surgery,The First Affiliated Hospital,Sun Yat-sen University Methods:The clinical data of Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangiocarcinoma patients who have undergone robotic-assisted resection at The First Affiliated Hospital,Sun Yat-sen University between July 2017 and May 2023 were retrospectively studied.The clinicopathological features and perioperative outcomes of the patients were analyzed.Results:Atotal of 9 patients with Bismuth-Corlette type III or IV perihilar cholangiocarcinoma,including 4 type Ⅲa patients,4 type Ⅲb patients and 1 type Ⅳ patient,received robotic-assisted resection.1 patient converted to open surgery.The median operation time was 645 min[interquartile range(IQR):554-745 min],the median intraoperative blood loss was 300 mL(IQR 15 0-650 mL),and the median number of lymph node retrieval was 1 1(IQR 6-12).7 patients(77.8%)had R0 resection.5 patients(55.6%)had postoperative major complications(ClaveinDindo classification was Ⅲ-Ⅴ),including intra-abdominal infection in 2 patients,liver function failure in 2 patients and upper gastrointestinal bleeding in 1 patient.1 patient underwent reoperation for the jejuno-jejunostomy bleeding 19 d after the initial operation and achieved good recovery.1 patient died within 30 d after initial operation due to liver function failure.The median length of postoperative hospital stay was 18 d(IQR 10-32 d).Conclusion:Robotic-assisted resection for Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangiocarcinoma is technically feasible and safe with good short-term efficacy,and can be performed in large-volume centers with ample experience in robotic-assisted hep atop ancreatobiliary surgery.更多还原