机器人辅助腹腔镜胆总管囊肿切除术的疗效分析  

Efficacy of robot-assisted laparoscopic resection for choledochal cysts

作　　者：李立帜[1] 徐迪[1] 林扬 曾少龙 李康 廖晓琴 Li Lizhi;Xu Di;Lin Yang;Zeng Shaolong;Li Kang;Liao Xiaoqin(Department of Pediatric Surgery,Provincial School of Clinical Medicine,Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Surgery,Fuzhou Children's Hospital Affiliated to Fujian Medical University,Fuzhou 350001,China;Department of Cardiac Surgery,Union Hospital Affiliated to Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院(福建省立医院)小儿外科,福州350001 [2]福建医科大学附属福州儿童医院外科,福州350001 [3]福建医科大学附属协和医院心外科,福州350001

出　　处：《中华肝胆外科杂志》2022年第12期898-901,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：福建省自然科学基金(2022J011010);福建省卫计委医学创新课题(2020CXB004)。

摘　　要：目的探讨机器人辅助腹腔镜胆总管囊肿切除术的临床效果。方法回顾性分析2020年10月至2022年6月福建医科大学省立临床医学院收治的胆总管囊肿患儿的临床资料。共纳入42例胆总管囊肿患儿, 其中男性16例, 女性26例, 年龄25(15.0, 45.0)个月。手术均为同一团队完成, 依据手术方式分为两组:行达芬奇机器人辅助腹腔镜手术的20例患儿为机器人组, 行单孔(经脐)腹腔镜手术治疗的22例患儿为腹腔镜组。收集患儿一般临床资料、观察并记录手术时间、术中出血量、禁食时间、住院时间、医疗总费用及并发症等。以门诊复诊方式进行随访。结果两组患儿手术均顺利完成, 无中转开腹发生。与腹腔镜组比较, 机器人组患儿的术中失血量[(10.65±3.75)比(14.86±3.75)ml]、腹腔引流管留置时间[(5.45±2.21)比(7.05±1.94)d]、禁食时间[(4.00±1.49)比(6.05±1.43)d]均减少, 而手术时长[394(299, 422)比351(269, 380)min]及住院费用[(7.92±0.40)比(3.11±0.30)万元]增加, 差异均有统计学意义(均P<0.05)。两组患儿术后并发症发生率及疼痛评分比较, 差异无统计学意义(均P>0.05)。截至随访结束时, 除腹腔镜组1例术后发生胆管炎的患儿外, 其他患儿暂未发现胆管炎、黄疸、肠梗阻及胆管癌等并发症。结论机器人辅助腹腔镜胆总管囊肿切除术治疗小儿胆总管囊肿疗效确切, 安全性良好。Objective To study the clinical results of robot-assisted laparoscopic resection for choledochal cysts.Methods From October 2020 to June 2022,clinical data on 20 patients who underwent choledochal da Vinci robot-assisted laparoscopic choledochal cyst resection at Fujian Provincial Hospital were retrospectively analyzed.Forty-two children with choledochal cysts were included in this study.There were 16 males and 26 females,aged 25(range 15.0 to 45.0)months.The operations were carried out by the same team of surgeons.These patients were divided into two groups based on the surgical methods:children who underwent da Vinci robot-assisted laparoscopic surgery were in the robotic group(n=20)and children who underwent single-port(transumbilical)laparoscopic surgery were in the laparoscopic group(n=22).The general clinical data,operation time,intraoperative blood loss,fasting time,hospital stay,total medical costs and complications were collectd and analysed.Follow-up was performed in outpatient visits.Results Both the 2 groups underwent surgery successfully,and no patient was converted to laparotomy.When compared with the laparoscopic group,intraoperative blood loss[(10.65±3.75)vs.(14.86±3.75)ml],indwelling time of abdominal drainage tube[(5.45±2.21)vs.(7.05±1.94)d]and fasting time[(4.00±1.49)vs.(6.05±1.43)d]in the robotic group were significantly less,while the operation time[394(299,422)vs.351(269,380)min]and hospitalization cost[(79200±4000)vs.(31100±3000)yuan]were significantly increased(all P<0.05).The differences in postoperative complication rates and pain score between the two groups showed no significant differences(all P>0.05).On follow-up,no patients developed complications such as cholangitis,jaundice,intestinal obstruction and cholangiocarcinoma,except for one patient in the laparoscopic group who developed cholangitis after surgery.Conclusion Robot-assisted laparoscopic choledochal cystectomy was effective and safe in treatment of children with choledochal cysts.

关 键 词：腹腔镜检查 机器人 胆总管囊肿 小儿 

分 类 号：R657.4[医药卫生—外科学]