机器人辅助腹腔镜胃底折叠术治疗小儿食管裂孔疝临床疗效评估  

Clinical efficacy of robot-assisted laparoscopic fundoplication for hiatal hernia in children

作　　者：汤笑妤 邬文杰[1] 龚一鸣[1] 潘伟华[1] 王俊[1] Tang Xiaoyu;Wu Wenjie;Gong Yiming;Pan Weihua;Wang Jun(Department of Pediatric Surgery,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿外科,上海200092

出　　处：《中华小儿外科杂志》2023年第7期592-596,共5页Chinese Journal of Pediatric Surgery

基　　金：上海申康医院发展中心临床研究项目(SHDC2020CR2063B)。

摘　　要：目的分析并评价达芬奇机器人手术系统辅助腹腔镜胃底折叠术治疗小儿食管裂孔疝的临床疗效。方法回顾性分析2021年10月至2022年7月就诊于上海交通大学医学院附属新华医院行机器人辅助腹腔镜胃底折叠手术治疗的18例食管裂孔疝患儿的临床资料。其中男12例,女6例;患儿出生时体重为(2951.54±402.63)g,范围在2350~3500 g;出生时孕周为(38.05±1.74)周,范围在35~41周。患儿入院时中位年龄为1.19岁,范围在0.35~17.85岁。18例患儿中先天性食管闭锁术后12例,腐蚀性食管炎3例,先天性膈疝术后2例,原发性食管裂孔疝1例。分析患儿手术操作时间、术中出血量、术后胃管留置时间、术后开始经口进食时间、住院时间及术后随访情况。结果18例患儿手术均顺利完成,17例行Nissen术,1例行Toupet术。手术操作时间为(97.69±52.18)min,范围在46~240 min。术中出血量为(8.41±6.87)ml,范围在3~30 ml。术后所有患儿均留置胃管,胃管留置时间为(4.24±3.35)d,范围在1~14 d。术后患儿开始经口进食时间为(3.41±1.46)d,范围在1~6 d。患儿总住院时间为(13.22±2.60)d,范围在8~17 d,术后住院时间为(7.94±2.73)d,范围在4~14 d。所有患儿随访(3.27±3.30)个月,无患儿发生严重术后并发症。4例患儿术后轻度进食缓慢,复查食管造影行胃食管连接处扩张术,中位扩张次数为2次。结论机器人辅助腹腔镜胃底折叠术治疗小儿食管裂孔疝是可行且安全的。当存在复发性或巨大型食管裂孔疝,术前评估手术难度较高时,更推荐使用机器人手术。Objective To evaluate the clinical efficacy of robot-assisted laparoscopic fundoplication for hiatal hernia in children.Methods From October 2021 to July 2022,18 children with hiatal hernia underwent robot-assisted laparoscopic fundoplication with da Vinci robotic system.There were 12 boys and 6 girls with an average birth weight of(2951.54±402.63)(2350-3500)gram and average gestational week of(38.05±1.74)(35-41).Median age was 1.19(0.35-17.85)years.Primary diagnosis was congenital esophageal atresia(n=12),caustic esophageal injury(n=3),congenital diaphragmatic hernia(n=2)and primary gastroesophageal reflux disease(n=1).Esophagogram was taken preoperatively for a definite diagnosis of hiatal hernia.Results All of them underwent robot-assisted laparoscopic fundoplication with da Vinci robotic system.Nissen fundoplication(n=17)and Toupet fundoplication(n=1)were performed.Average intraperitoneal operative duration was(97.69±52.18)(46-240)min and intraoperative blood loss(8.41±6.87)(3-30)ml.Average length of gastric drainage was(4.24±3.35)(1-14)day,average time to resume oral intake(3.41±1.46)(1-6)day and mean length of hospitalization(13.22±2.60)(8-17)and(7.94±2.73)(4-14)day.Upper gastrointestinal series were examined post-operation.There was no instance of mortality or major complications.Four children underwent postoperative esophageal dilatation by esophagography and average number of dilatation was 2(1-4).Conclusions Robot-assisted fundoplication is both safe and feasible in children.Da Vinci robotic system is efficacious for repairing recurrent or giant hiatal hernia.

关 键 词：疝 食管裂孔 胃食管反流 机器人手术 胃底折叠术 

分 类 号：R726.5[医药卫生—儿科]