机器人辅助腹腔镜在活体供肝左外叶切取术中的应用  

Clinical application of robotic-assistant living donor left lateral segmentectomy

作　　者：张雅敏[1] 高伟[2] 崔子林[1] 董冲[2] 冯睿 孙超[2] 白易 沈中阳[2] Zhang Yamin;Gao Wei;Cui Zilin;Dong Chong;Feng Rui;Sun Chao;Bai Yi;Shen Zhongyang(Department of Hepatobiliary and Pancreatic Surgery,First Central Municipal Hospital,Tianjin 300192,China;Organ Transplantation Center,First Central Municipal Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院肝胆胰外科,天津300192 [2]天津市第一中心医院器官移植中心,天津300192

出　　处：《中华器官移植杂志》2023年第6期339-345,共7页Chinese Journal of Organ Transplantation

基　　金：天津市自然科学基金(20JCYBJC01310,21JCYBJC00320);天津市科技计划项目(19ZXDBSY00010);天津市卫生健康科技项目(TJWJ2021ZD002,ZC20218)。

摘　　要：目的:探讨机器人辅助腹腔镜下活体供肝切取术的可行性和安全性。方法:回顾性分析2021年6月至2022年9月天津市第一中心医院器官移植中心行活体左外叶供肝切取45例供者及受者的临床资料。其中,15例行机器人辅助腹腔镜下活体供肝切取(机器人辅助手术组),30例行传统开腹供肝切取(传统开腹手术组)。对比分析两组手术时间、术中出血、术后恢复、术后并发症等情况。采用SPSS 21.0进行统计学分析,进行独立样本T检验、配对样本T检验、Wilcoxon秩和检验和卡方检验来分析两组之间的差异。结果:传统开腹手术组的手术时间、术中出血量和术后住院时间分别为(236.0±58.7)min、(251.0±144.8)ml和7.0(6.0,9.0)d,与机器人辅助手术组(337.5±66.7)min、(106.0±39.8)ml和6.0(6.0,6.0)d比较,差异均有统计学意义(P<0.001、P=0.001和P<0.05)。传统开腹手术组供者术后出现胆漏2例;腹腔感染2例,其中1例为肝断面胆漏引起,最终行二次剖腹手术;切口感染1例;肝中静脉及其部分分支血栓形成1例。机器人辅助手术组仅1例供者术后出现血淀粉酶升高。随访超过6个月者中,机器人辅助手术组无远期并发症发生,传统开腹手术组有1例供者发生肝中静脉局部血栓以及1例胆管狭窄。传统开腹手术组受者的手术时间、术中出血量、术后住院时间和术后出现腹腔细菌感染例数分别为(9.3±1.1)h、(284.9±123.2)ml、29.0(17.0,49.0)d和24例(80.0%),与机器人辅助手术组(9.5±1.5)h、(356.4±179.7)ml、23.0(17.0,29.0)d和9例(60.0%)比较,差异均无统计学意义(P=0.634、0.180、0.866和0.153)。结论:从本次研究结果看,机器人辅助技术在供肝切取手术中的应用是安全可靠的,在住院时间、术中出血量、术后并发症方面均优于传统的开腹供肝切取术。Objective To explore the feasibility and safety of robotic-assisted living donor left lateral segmentectomy(LDLLS)in a large pediatric liver transplant program.Methods Retrospective analysis was performed for clinical data of 45 LDLLS donors and recipients from June 2021 to September 2022.Traditional open donor liver resection(n=30)and robotic-assisted segmentectomy(n=15)were performed.Two groups were compared with regards to operative duration,intraoperative hemorrhage,postoperative healing and postoperative complications.SPSS 21.0 was utilized for statistical analysis.Independent sample T,paired sample T,Wilcoxon rank sum and Chi-square tests were performed for examining the inter-group differences.Results Operative duration of robot-assisted surgery group was substantially longer than that of traditional open surgery group(P<0.001).Intraoperative blood loss was less in robot-assisted surgery group was less than that in traditional open surgery group[(106.0±39.8)vs.(251.0±144.8)ml,P=0.001].Postoperative hospital stay of robot-assisted surgery group was shorter than that of traditional open surgery group[6.0(6.0,6.0)vs.7.0(6.0,9.0),P<0.05].Two cases of postoperative biliary leakage were observed in donor of traditional open surgery group.Among 2 cases of abdominal infection,one was due to biliary leakage from liver section and secondary surgery was then performed.One case of incisional infection and another case of thrombosis occurred in donor of traditional open surgery group.In robot-assisted surgery group,only one donor had amylase elevation.In traditional open surgery group,there were one case of local thrombosis in middle hepatic vein and one case of bile duct stricture.No long-term complications occurred in robot-assisted surgery group during a follow-up period of over 6 months.Finally recipient data analysis indicated that no significant inter-group differences existed in operative duration,intraoperative blood loss,postoperative hospital stay or postoperative abdominal infection(P=0.634,P=0.180,P=0.86

关 键 词：儿童 活体肝移植 机器人辅助腹腔镜手术 经腹手术 

分 类 号：R657.3[医药卫生—外科学]