达芬奇机器人手术系统辅助儿童胆总管囊肿切除术的临床疗效分析  

Clinical efficacy of Da Vinci(SI)robot-assisted choledochal cyst excision in pediatrics

作　　者：谢小龙 李可为[1] 王川[1] 王琦[1] 李福玉[1] 向波[1] Xie Xiaolong;Li Kewei;Wang Chuan;Wang Qi;Li Fuyu;Xiang Bo(Department of Pediatric Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《中华小儿外科杂志》2021年第7期610-616,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨达芬奇机器人手术相对于传统开放手术、腹腔镜手术治疗儿童胆总管囊肿的安全性及临床疗效。方法收集2015年1月至2019年6月于四川大学华西医院小儿外科接受3种手术方式治疗的401例胆总管囊肿患儿的临床资料,分析术前、围手术期、术后随访的临床数据。所有患儿中,男94例,女307例,男∶女=1∶3.27;将229例接受开放手术的患儿作为开放组,将118例接受腹腔镜手术的患儿作为腹腔镜组,将54例接受达芬奇机器人手术的患儿作为机器人组;274例表现为腹痛、呕吐178例、腹胀36例、黄疸114例、腹部包块38例;Ⅰ型胆总管囊肿341例,Ⅱ型1例,Ⅳ型59例。结果腹腔镜组手术时间为(216.14±35.57)min,机器人组为(181.28±14.07)min,开放组为(115.88±13.41)min,3组间的差异具有明显的统计学意义(P<0.001)。腹腔镜组术中液体输入量为(525.20±85.29)ml,明显高于开放组(312.75±59.13)ml和机器人组(400.74±35.16)ml,差异具有统计学意义(P<0.001)。开放组术中出血量为(40.12±55.17)ml,明显高于腹腔镜组(21.82±11.15)ml和机器人组(21.85±9.82)ml,而腹腔镜组和机器人组术中出血量之间的差异无明显统计学意义(P=0.987)。腹腔镜组有6例术中中转开放手术,机器人组无中转开放的患儿。腹腔镜组和机器人组之间在进食流质时间、进食固体时间和住院时间的差异均无统计学意义(P>0.05),均明显低于开放组。开放组发生并发症有7例[3.06%(7/229)];腹腔镜组发生并发症有9例[7.63%(9/118)];机器人组发生并发症有2例[3.70%(2/54)];3组的并发症发生率之间的差异无统计学意义(P=0.087)。机器人组住院费用为62320元,腹腔镜组为35030元,开放组为28450元,3组间在住院费用的差异具有统计学意义(P<0.001)。结论达芬奇机器人手术系统辅助儿童胆总管囊肿切除术相较于传统腹腔镜手术明显降低了手术难度,其疗效接近于开放手术,切口美观度弱于�Objective To explore the safety and effectiveness of open,laparoscopic or robot-assisted excisions for pediatric choledochal cyst.Methods from January 2015 to June 2019,401 children with choledochal cysts undergoing open,laparoscopic or robot-assisted procedures were retrospectively analyzed.The relevant data included demographic profiles,cyst type/size,operative findings and postoperative outcomes.There were 94 boys and 307 girls with a male-to-female ratio of 1∶3.27.They were assigned into three groups of open(n=229),laparoscopic(n=118)and robot-assisted(n=54).There were abdominal pain(n=274),vomiting(n=178),abdominal distension(n=36),jaundice(n=114)and abdominal mass(n=38).The clinical types were I(n=341),Ⅱ(n=1)andⅣ(n=59).Results Operative duration was significantly longer in laparoscopic group(216.14±35.57)mins than open group(115.88±13.41)mins and robot-assisted group(181.28±14.07)mins with a significant difference(P<0.001).Total volumes of intraoperative fluid input were significantly higher in laparoscopic group(525.20±85.29)ml than open group(312.75±59.13)ml and robot-assisted group(400.74±35.16)ml with a significant difference(P<0.001).The volume of intraoperative bleeding was higher in open group(40.12±55.17)ml than in laparoscopic group(21.82±11.15)ml and robot-assisted group(21.85±9.82)ml while there was no significant inter-group difference(P=0.987).Six children scheduled for laparoscopy were later converted into open surgery while there was no conversion into laparotomy in robot-assisted group.Time to drink water,time to starting a liquid diet and average length of postoperative hospital stay were similar between laparoscopic and robot-assisted groups.Both were shorter than that of open group with significant differences.The rate of complications was 7.63%(9/118)in laparoscopic group,3.70%(2/54)in robot group and 3.06%(7/229)in open group.No significant difference existed in complications among three groups.Hospitalization expenses in open,laparoscopic and robot-assisted groups were 2

关 键 词：胆总管囊肿 达芬奇机器人手术系统 儿童 疗效 

分 类 号：R726.5[医药卫生—儿科]