机器人辅助腹腔镜儿童胰腺实性假乳头状瘤剜除术的疗效评价  

Efficacy evaluation of robot-assisted laparoscopic excision of solid pancreastic pseudopapilloma in children

作　　者：宣笑笑 张书豪 蔡多特[1] 高志刚[1] 罗文娟[1] 陈肯[1] 胡迪 陈青江[1] Xuan Xiaoxiao;Zhang Shuhao;Cai Duote;Gao Zhigang;Luo Wenjuan;Chen Ken;Hu Di;Chen Qingjiang(Department of Pediatric Surgery,Affiliated Children's Hospital,Zhejiang University School of Medicine/National Clinical Research Center for Children's Health&Diseases,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属儿童医院普外科,国家儿童健康与疾病临床医学研究中心,杭州310000

出　　处：《临床小儿外科杂志》2024年第11期1072-1076,共5页Journal of Clinical Pediatric Surgery

基　　金：浙江省自然科学基金(LY20H030007)。

摘　　要：目的初步评估机器人辅助腹腔镜手术在儿童胰腺实性假乳头状瘤治疗中的应用价值。方法回顾性分析2020年4月至2023年7月浙江大学医学院附属儿童医院收治的5例胰腺实性假乳头状瘤患儿临床资料。收集患儿病变位置、影像学检查结果、术前及术后实验室检查结果、手术时间、术中出血量、引流管放置时间、术中及术后并发症、住院天数、术后病理诊断。结果男1例,女4例;年龄6岁9个月至14岁9个月,中位年龄10岁11个月;体重21.5~45.0 kg,中位体重29.1 kg。5例术前B超、增强CT或磁共振等检查均提示胰腺实性假乳头状瘤,均行机器人辅助腹腔镜胰腺肿瘤剜除术,其中1例术中因胰管损伤行胰管修补,手术时间95~180 min(中位手术时间103 min),无一例中转开腹手术。术后病理结果为胰腺实性假乳头状瘤。术后住院时间7~20 d,中位术后住院时间14 d。术前白细胞计数7.600(7.300,10.000)×10^(9)/L、超敏C反应蛋白0.200(0.200,0.460)mg/L、丙氨酸转氨酶11.000(9.000,17.000)U/L、天门冬氨酸转氨酶24.000(21.000,35.000)U/L、血淀粉酶67.700(62.900,107.100)U/L、脂肪酶23.500(21.200,53.700)U/L;术后白细胞计数5.190(5.070,5.590)×10^(9)/L、超敏C反应蛋白7.520(1.080,7.800)mg/L、丙氨酸转氨酶17.000(15.000,34.000)U/L、天门冬氨酸转氨酶35.000(28.000,42.000)U/L、血淀粉酶95.700(73.000,104.400)U/L、脂肪酶62.300(58.900,64.000)U/L。手术前后上述指标对比,差异均无统计学意义(P>0.05)。5例均顺利出院,出院后随访2~36个月,无一例胰腺炎、胰漏、胰管狭窄、肿瘤复发等并发症发生。结论机器人辅助腹腔镜手术用于儿童胰腺实性假乳头状瘤安全、可行,其解剖清晰,操作精细,术后恢复快,是胰腺实性假乳头状瘤微创手术的理想选择。ObjectiveTo evaluate the application of robot-assisted laparoscopy for solid pancreastic pseudopapilloma(SPP)in children.MethodsFrom April 2020 to July 2023,retrospective analysis was conducted for the relevant clinical data of 5 SPP children.Lesion sites,imaging examinations,periostoperative laboratory tests,operative duration,intraoperative volume of blood loss,drainage tubing time,perioperative complications,length of hospitalization and postoperative pathological examinations were recorded.ResultsThere were 1 boy and 4 girls,ranging in age from 6 years 9 months to 14 years 9 months,with a median age of 10 years 11 months.Weight 21.5-45.0 kg,median weight 29.1 kg.Preoperative imaging examinations of ultrasonography,enhanced computed tomography(CT)and magnetic resonance imaging(MRI)hinted at SPP.Robot-assisted laparoscopic resection was performed with a median operative duration of 103(95-180)min.There was no conversion into open surgery.One child of intraoperative pancreatic duct rupture was repaired.SPP was confirmed by postoperative pathological examination.The median postoperative hospitalization stay was 14(7-20)day.Preoperative leucocyte count was 7.600(7.300,10.000)×10^(9)/L,high-sensitivity C-reactive protein(Hs-CRP)0.200(0.200,0.460)mg/L,alanine aminotransferase(ALT)11.000(9.000,17.000)U/L,aspartate aminotransferase(AST)24.000(21.000,35.000)U/L,amylase 67.700(62.900,107.10)U/L,lipase 23.500(21.200,53.700)U/L;Postoperative leucocyte count was 5.190(5.070,5.590)×10^(9)/L,Hs-CRP 7.520(1.080,7.800)mg/L,ALT 17.000(15.00,34.000)U/L,AST 35.000(28.000,42.000)U/L,amylase 95.700(73.000104.400)U/L,lipase 62.300(58.900,64.000)U/L.The comparison of leucocyte count,Hs-CRP,ALT,AST,amylase and lipase before and after surgery showed p-values greater than 0.05.There were no statistically significant differences.All of them were discharged smoothly.During a follow-up period of 2 to 36 month,there was no onset of pancreatitis,pancreatic leakage,pancreatic duct stenosis or recurrence.ConclusionsFor SPP children,robot-ass

关 键 词：机器人手术 腹腔镜 胰腺肿瘤 外科手术 儿童 

分 类 号：R73[医药卫生—肿瘤]