达芬奇技术与传统腹腔镜技术在胆总管囊肿根治术中应用的对比研究  

Comparative study of Da Vinci technique versus traditional laparoscopic technique in the treatment of choledochal cyst

作　　者：蔡多特[1] 陈青江[1] 章立峰[1] 章跃滨[1] 潘涛[1] 陈肯[1] 罗文娟[1] 金益 黄宗伟 高志刚[1] Cai Duote;Chen Qingjiang;Zhang Lifeng;Zhang Yuebin;Pan Tao;Chen Ken;Luo Wenjuan;Jin Yi;Huang Zongwei;Gao Zhigang(Department of General Surgery,the Children's Hospital,Zhejiang University school of Medicine,National Clinical Research Center For Children's Health,Zhejiang Clinical Research Center of Mini-invasive Diagnosis and Treatment of Abdominal Diseases,Hangzhou 310053,China)

机构地区：[1]浙江大学医学院附属儿童医院普外科,国家儿童健康与疾病临床医学研究中心,浙江省腹腔脏器微创诊治临床医学研究中心,杭州310053

出　　处：《临床小儿外科杂志》2022年第1期51-57,共7页Journal of Clinical Pediatric Surgery

基　　金：国家重点研发计划(2018YFC1002700);浙江省腹腔脏器微创诊治临床医学研究(01492-02);浙江省医药卫生科技计划项目(2017KY434);浙江省卫生健康科技计划(2022RC201)。

摘　　要：目的比较达芬奇机器人与传统腹腔镜胆总管囊肿根治术的治疗效果,并总结两种方法的优缺点。方法收集浙江大学医学院附属儿童医院普外科2020年4月至2020年12月完成的达芬奇机器人辅助胆总管囊肿根治术及传统腹腔镜胆总管囊肿根治术的44例患儿作为研究对象,依据手术方式的不同分为达芬奇手术组(n=25)和腹腔镜手术组(n=19)。比较两组手术时长、术中中转开腹比例、囊肿型胆总管囊肿术中能否探及远端开口情况、术中出血量、术后禁食时间、术后腹腔引流管留置天数、术后住院天数、住院费用以及术后并发症等临床资料,分析两种手术方法的优劣。结果达芬奇手术组手术时长为(189.4±35.5)min,腹腔镜手术组手术时长为(167.1±33.9)min,差异有统计学意义(t=2.105,P=0.039);两组术中转开腹手术比例比较,差异无统计学意义(P>0.05);囊肿型胆总管囊肿病例中探及远端开口比例,达芬奇手术组高于腹腔镜手术组(66.7%vs.16.7%),差异有统计学意义(χ^(2)=6.750,P=0.009);两组术中出血量、术后禁食时间比较,差异无统计学意义(P>0.05)。术后引流管留置时长,达芬奇手术组为6(6~9)d,腹腔镜手术组为8(7~10)d,差异有统计学意义(Z=-2.226,P=0.026)。术后住院时长,达芬奇手术组为(8.7±2.3)d,腹腔镜手术组为(11.0±2.5)d,差异有统计学意义(t=-3.044,P=0.004)。住院费用,达芬奇手术组为7.5(7.3~8.6)万元,腹腔镜手术组为3.2(2.7~3.6)万元,差异有统计学意义(Z=-4.450,P<0.001)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论达芬奇机器人辅助胆总管囊肿根治术是一项安全可行的新技术,较腹腔镜胆总管囊肿根治术更适合需要更精细操作的病例,其术后恢复优于腹腔镜手术。Objective Objective To explore the advantages and disadvantages of Da Vinci robot versus traditional laparoscopic assisted surgery for choledochal cyst.Methods From April 2020 to December 2020,44 cases of choledochal cyst were divided into Da Vinci operation group(n=25)and laparoscopy group(n=19).Operative duration,proportion of conversion into laparotomy,proportion of distal opening of cystic choledochal cyst,volume of blood loss,fasting time,postoperative indwelling days of abdominal drainage tube,postoperative hospital stay,hospitalization expenses and postoperative complications were compared between two groups.Results Operative duration was(189.4±35.5)min in Da Vinci group and(167.1±33.9)min in laparoscopic group.And the difference was statistically significant(t=2.105,P=0.039).No intergroup statistical difference existed in conversion into laparotomy(P>0.05);detection rate of distal opening of cystic choledochal cyst was higher in Da Vinci group than that in laparoscopic group(66.7%vs.16.7%)and the difference was statistically significant(χ^(2)=6.750,P=0.009).No intergroup statistical difference existed in intraoperative volume of blood loss or postoperative fasting time(P>0.05).Postoperative indwelling days of abdominal drainage tube was 6(6-9)days in Da Vinci group and 8(7-10)days in laparoscopic group.And the difference was statistically significant(Z=-2.226,P=0.026).Postoperative hospital stay was(8.7±2.3)days in Da Vinci group and(11.0±2.5)days in laparoscopic group.The difference was statistically significant(t=-3.044,P=0.004).In terms of hospitalization expenses,Da Vinci group was significantly higher than laparoscopic group and the difference was statistically significant(Z=-4.450,P<0.001).No intergroup statistical difference existed in the incidence of complications(P>0.05).Conclusion Da Vinci robot assisted radical choledochocystectomy is both safe and feasible.It is ideal for children requiring meticulous operations and its postoperative recovery is faster than that of traditiona

关 键 词：外科手术 机器人 腹腔镜 胆总管囊肿 治疗结果 

分 类 号：R726.5[医药卫生—儿科]