全球首例不阻断第一肝门的机器人肝切除术治疗儿童肝母细胞瘤  

Robotic hepatectomy in a 14-month-old child of hepatoblastoma without the first hepatic portal control:a first case report in the world

作　　者：徐晓钢 曾纪晓 罗媛圆 刘斐 陶波圆 兰梦龙 梁子建 王欣星 Xu Xiaogang;Zeng Jixiao;Luo Yuanyuan;Liu Fei;Tao Boyuan;Lan Menglong;Liang Zijian;Wang Xinxing(Department of Gastrointestinal Surgery,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,National Children's Medical Center For South Central Region,Guangzhou 510120,China)

机构地区：[1]国家儿童区域医疗中心,广州医科大学附属妇女儿童医疗中心胃肠外科,广州510120

出　　处：《临床小儿外科杂志》2023年第12期1114-1118,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州地区临床特色技术项目(2023C—TS48);广州市卫生健康科技项目(20231A011040)

摘　　要：目的总结全球首例不阻断第一肝门的机器人肝切除术治疗儿童肝母细胞瘤(hepatoblastoma,HB)的手术经验。方法回顾性分析2023年6月广州市妇女儿童医疗中心经机器人手术治疗的1例14月龄HB患儿诊疗经过。该患儿肿瘤位于肝右叶S5、S6,大小约9.0 cm×6.9 cm×6 cm,行达芬奇机器人肝切除术,总结术中Trocar布局、手术技巧、围术期处理情况以及治疗结局等。结果术中采用4条机械臂加1个辅助孔,未阻断第一肝门,使用超声刀及Hemo-lock凝断并结扎肝脏血管,完整切除肿瘤(S5、S6、部分S7及胆囊)。手术时间120 min,出血量50 mL。术后无胆漏、出血、感染等并发症,病理检查结果提示胎儿上皮型HB,术后第7天达出院指征,术后第14天予C5V(顺铂+5-氟尿嘧啶+长春新碱)方案化疗。术后30 d、53 d及90 d血甲胎蛋白(alpha fetoprotein,AFP)分别为36.88 ng/mL、8.90 ng/mL、6.61ng/mL,超声检查未见新发病灶。经查新,此例为全球首例不阻断第一肝门的机器人肝切除术治疗儿童HB。结论运用达芬奇机器人可以在不阻断第一肝门的情况下实施非解剖性肝切除术治疗儿童HB,手术安全、可行,但目前相关报道较少,需继续积累病例及经验。Objective To summarize the surgical experiences of the first-ever global case of robotic hepatectomy(RH)in a child with hepatoblastoma(HB)without the first hepatic portal control.Methods A 14-month-old HB boy reviewed retrospectively.Located in right hepatic lobe S5/S6,tumor had a dimension of 9.0×6.9×6 cm.RH was performed with Da Vinci system.Trocar positioning,operative skills and perioperative managements of pediatric robotic hepatectomy were recorded.Results Without the first hepatic control(Pringle),hepatic vessels were ligated by an ultrasonic knife with a Hemo-lock.Tumors(S5,S6,partial S7&gallbladder)were completely removed with four robotic arms and one auxiliary hole.Operative duration was 120 min and volume of blood loss 50 ml.There were no such postoperative complications as bile leakage,hemorrhage or infection.Postoperative pathology hinted at HB.Discharge index was attained at Day 7 post-RH.C5V chemotherapeutic regimen(cisplatin+5-fluorouracil+vincristine)was offered at Day 14.AFP was 36.88,8.90 and 6.61 ng/ml at Month 1,Day 53 and Month 3 post-RH.No new lesions were detected by ultrasonography.Conclusions RH is both safe and feasible for infantile HB without the first hepatic control(Pringle).Currently there are few related reports of RH in children.It is imperative to continue expanding cases and accumulating experiences.

关 键 词：肝母细胞瘤 机器人手术 肝切除术 治疗结果 儿童 

分 类 号：R735.7[医药卫生—肿瘤]