机器人与腹腔镜技术在改良Soave短肌鞘吻合术治疗先天性巨结肠中的应用  

Comparison of Da Vinci robot-assisted versus laparoscopic-assisted modified Soave with short muscular cuff anastomosis for classical Hirschsprung's disease

作　　者：郑泽兵 王维鳌 李严易 汤成艳 龚元 夏兴容 杜青 黄露 祝代威 周万康 李泽平 金祝 刘远梅 Zheng Zebing;Wang Wei'ao;Li Yanyi;Tang Chengyan;Gong Yuan;Xia Xingrong;Du Qing;Huang Lu;Zhu Daiwei;Zhou Wankang;Li Zeping;Jin Zhu;Liu Yuanmei(Department of Pediatric Surgery,Affiliated Hospital,Zunyi Medical University,Guizhou Provincial Children's Hospital,Zunyi 563000,Chin)

机构地区：[1]遵义医科大学附属医院贵州省儿童医院小儿外科,遵义563000

出　　处：《临床小儿外科杂志》2024年第10期946-951,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82060100);贵州省基础研究项目(黔科合基础ZK—2021—361)。

摘　　要：目的探讨达芬奇手术机器人辅助下改良Soave短肌鞘吻合术和腹腔镜辅助下改良Soave短肌鞘吻合术在先天性巨结肠(Hirschsprung's disease,HSCR)患儿中的疗效差异。方法回顾性分析2021年1月至2023年12月在遵义医科大学附属医院接受手术治疗的60例HSCR患儿临床资料,按手术方式分为机器人手术组(25例)和腹腔镜手术组(35例)。收集两组手术年龄、体重,手术时间,肛门解剖手术时间,术中出血量,住院时间,手术费用;比较两组术后小肠结肠炎发生率,吻合口并发症率(吻合口梗阻、吻合口漏、直肠阴道瘘);采用排便评分系统随访两组术后排便控制情况。结果机器人手术组与腹腔镜手术组患儿肛门分离时间[(20.2±3.3)min比(33.1±5.6)min]、术后出血量[(11.0±6.0)mL比(16.9±13.2)mL]、住院费用[(4.6±0.3)万元比(3.8±0.6)万元]、吻合口并发症发生率(0/25比6/35)、排便频率[(2.4±0.8)次比(3.4±1.2)次]、污便次数[(0.72±0.73)次比(1.4±0.9)次]以及排便功能评分[(7.7±0.9)分比(6.8±0.9)分]比较,差异均有统计学意义(P<0.05);两组患儿手术时间、术后住院时间、术后小肠结肠炎发生率比较,差异无统计学意义(P>0.05)。结论与腹腔镜辅助下改良Soave短肌鞘吻合术相比,达芬奇手术机器人辅助下改良Soave短肌鞘吻合术治疗HSCR可缩短肛门部操作时间,减少HSCR术后吻合口并发症,改善术后排便功能。Objective To compare the efficacy of Da Vinci robot-assisted and laparoscopic-assisted modified Soave with short muscular cuff anastomosis procedures for classical Hirschsprung disease(HSCR).Methods From January 2021 to December 2023,60 HSCR children undergoing operations were retrospectively reviewed.According to operative techniques,they were assigned into two groups of robot(n=25)and laparos-copy(n=35).Operative age,body weight,operative duration,anal dissection time,intraoperative volume of blood loss,hospitalization stay length and hospitalization expense were recorded.Incidence of postoperative en-terocolitis and anastomotic complications(anastomotic obstruction,anastomotic leakage&rectovaginal fistula)were compared between two groups.Postoperative defecation control status was tracked through defecation scoring system.Results Between robot and laparoscopic groups,dissection duration(20.2±3.3 us.33.1±5.6 min),intraoperative volume of blood loss(11.0±6.0 vs.16.9±13.2 ml),hospitalization expense[(46±3)vs.(38±6)thousand yuan],incidence of anastomotic complications[(0%,0/25)us.(17.1%,6/35)],defecation frequency[(2.4±0.8)vs.(3.4±1.2)],soiling frequency[(0.72±0.73)us.(1.4±0.9)]and postoperative defecation function score[(7.7±0.9)us.(6.8±0.9)].The differences were statistically sig-nificant(P<0.05).However,operative duration,hospitalization stay length and incidence of enterocolitis were not statistically significant(P>0.05).Conclusions As compared with laparoscopic-assisted approach,Da Vinci robot-assisted modified Soave with short muscular cuff anastomosis can shorten operative duration of anal dissection,lower the incidence of anastomotic complications and improve defecation function in HSCR children.

关 键 词：腹腔镜 先天性巨结肠 外科手术 儿童 

分 类 号：R72[医药卫生—儿科]