机器人辅助完全腹腔镜下手术一期治疗胰十二指肠Ⅴ级复合损伤  

Emergency treatment of complex pancreatoduodenal injuries gradeⅤwith robot-assisted complete laparoscopic pancreatojejunostomy in a child:the first case report

作　　者：兰梦龙 曾纪晓 徐晓钢 叶志华 刘斐 Lan Menglong;Zeng Jixiao;Xu Xiaogang;Ye Zhihua;Liu Fei(Department of Gastrointestinal Surgery,Guangzhou Women&Children’s Medical Center,Guangzhou Medical University,National Children’s Medical Center for South Central Region,Guangzhou 510120,China)

机构地区：[1]国家区域儿童医疗中心、广州医科大学附属妇女儿童医疗中心胃肠外科,广州510120

出　　处：《临床小儿外科杂志》2025年第1期73-78,共6页Journal of Clinical Pediatric Surgery

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(202201010612、2023A03J0865);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：目的总结急诊行机器人辅助完全腹腔镜下十二指肠修补+胰体空肠吻合术一期治疗胰十二指肠Ⅴ级复合损伤的手术经验。方法回顾性分析2024年6月广州医科大学附属妇女儿童医疗中心胃肠外科急诊行机器人辅助手术一期治疗的1例胰十二指肠Ⅴ级复合损伤患儿的诊疗经过。总结机器人辅助完全腹腔镜下十二指肠修补术、胰体空肠吻合术的Trocar布局、手术步骤及关键点、围手术期管理及治疗结局等相关经验。结果患儿男,8岁,因"自行车把撞击腹部后腹痛、呕吐29 h"自外院转入,术前影像学检查提示为胰头断裂、十二指肠穿孔,急诊行机器人辅助完全腹腔镜下十二指肠修补、胰体空肠吻合术,手术使用达芬奇机器人手术系统,采用"4臂加1辅助孔法",手术时长11 h,出血量50 mL,术中输红细胞悬液1 U,术后给予抑酸、生长抑素、静脉营养等治疗,术后无出血、胰漏、胆漏、肠漏等严重并发症,术后14 d出院。结论急诊行机器人辅助完全腹腔镜下十二指肠修补、胰体空肠吻合术治疗儿童胰十二指肠Ⅴ级复合损伤能够一期达到根治目标,术后恢复快,住院时间短。Objective To summarize the first case of surgical experience of emergency treatment of complex pancreatoduodenal injuries with robot-assisted complete laparoscopic pancreatojejunostomy in a child with pancreaticoduodenal injuries.Methods A retrospective analysis was conducted for the diagnosis and treatment of an 8-year-old boy with pancreaticoduodenal injuries gradeⅤundergoing robot-assisted surgery in June 2024.This report summarized Trocar layout,operative essentials,perioperative management and treatment outcomes.Results He was admitted because of abdominal pain and vomiting for 29 h after abdomen injury of a bicycle handlebar.Preoperative imaging examination revealed pancreatic head rupture and duodenal perforation.Robot-assisted complete laparoscopic duodenal repair and pancreaticojejunostomy were performed.Da Vinci robotic surgical system was utilized with a 4-arm method and 1 auxiliary hole.Operative duration was 11 h and intraoperative volume of blood loss 50 mL.And 1 U of red blood cell suspension was transfused during operation.After operation,acid suppression,hemostasis,somatostatin and intravenous nutrition were offered.There were no serious postoperative complications such as hemorrhage,pancreatic fistula,biliary fistula or intestinal fistula.Discharge occurred at Day 14 post-operation.Conclusions Emergency robot-assisted laparoscopic duodenal repair pancreatojejunostomy is both safe and effective for children with combined pancreaticoduodenal injuries,with rapid postoperative recovery and short hospitalization stay.

关 键 词：腹腔镜 胰管空肠吻合术 外科手术 儿童 机器人手术 

分 类 号：R65[医药卫生—外科学]