达芬奇机器人辅助Swenson-like巨结肠根治术  

Da Vinci robotic-assisted Swenson-like pull through for Hirschsprung disease

作　　者：曾纪晓 徐晓钢 王欣星 刘斐 兰梦龙 陶波圆 梁子建 叶志华 罗媛圆 Jixiao Zeng;Xiaogang Xu;Xinxing Wang;Fei Liu;Menglong Lan;Boyuan Tao;Zijian Liang;Zhihua Ye;Yuanyuan Luo(Department of Gastrointestinal Surgery,National Children Regional Medical Center,Guangzhou Women and Children′s Medical Center,Guangzhou Medical University,Guangdong 510120,China)

机构地区：[1]国家儿童区域医疗中心(中南)、广州医科大学附属妇女儿童医疗中心胃肠外科,广东510120

出　　处：《中华腔镜外科杂志（电子版）》2024年第4期239-243,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州地区临床特色技术项目(2023C-TS48);卫生健康技术重点推广项目(XM202403895)。

摘　　要：目的探讨达芬奇机器人辅助Swenson-like巨结肠根治术治疗8个月以内婴儿先天性常见型巨结肠的安全性、可行性、治疗效果和并发症。方法以广州医科大学附属妇女儿童医疗中心胃肠外科40例先天性常见型巨结肠患儿为研究对象,由同一外科医师实施手术,术式为三臂法机器人辅助Swenson-like巨结肠根治术。回顾性收集患儿术前、术中和术后临床资料进行分析,术后随访10~18个月。结果40例(男30例,女10例)先天性病患儿巨结肠(Hirschsprung disease,HSCR),平均手术月龄6±2个月,全部顺利完成手术,均无需中转开放及增加辅助孔,平均手术时间为152±17 min,其中机器人手术操作时间43±16 min,肛门部直肠分离时间6±2 min,术中出血量为2±1 ml,平均切除肠管长度25±7 cm,肠功能恢复时间为8±2 h,住院时间为6±1 d,术后疼痛评分为2±1分;40例术后6例(15%)需行肛门扩张;全部患儿均痊愈出院,围术期内均无手术并发症发生,术后主要并发症为肛周皮炎(7.5%)和小肠结肠炎(7.5%)。结论达芬奇机器人辅助Swenson-like巨结肠根治术适用于婴儿期先天性常见型巨结肠的治疗,近期效果良好。Objective To explore the safety and practicality of da Vinci robotic-assisted Swenson-like pull through for Hirschsprung disease in children less than 8 months old,as well as the treatment effects and complications.Methods The study focused on 40 pediatric patients with the common segment of Hirschsprung disease who were treated at the Department of Gastrointestinal Surgery of Guangzhou Women and Children′s Medical Center.The operation was conducted by the same surgeon,utilizing da Vinci robotic-assisted Swenson-like pull through.Patients′clinical data were collected before,during,and after surgery for analysis,and they were followed up on for 10-18 months after surgery.Results All patients(30 males,10 females),with a mean age of 6±2 months,successfully underwent the robotic-assisted Swenson-like procedure.The total operation time was 152±17 minutes on average,comprising 43±16 minutes for robotic operation,and 6±2 minutes for anal separation.The average intraoperative blood loss was 2±1ml.The average length of the resected intestine was 25±7 cm.The average recovery time for intestinal function was 8±2 hours.The average hospital stay was 6±1 days.The average score for postoperative pain was 2±1 points.6 out of the 40 patients required anal dilatation after the surgery.A total of 40 patients were discharged after recovery with no perioperative issues.Additionally,perianal dermatitis(7.5%)and enterocolitis(7.5%)were the most common postoperative complications.Conclusion Da Vinci robotic-assisted Swenson-like pull through is suitable for the common segment of Hirschsprung disease in children under 8 months of age,and it has demonstrated satisfactory short-term outcomes.

关 键 词：先天性巨结肠 机器人手术 儿童 Swenson 

分 类 号：R574.62[医药卫生—消化系统]