达芬奇机器人手术与传统开腹手术治疗胆道闭锁的早期疗效对比

Comparison of early efficacies ects in between Da Vinci's robot surgery and versus open kasai surgery in the treatment of for biliary atresia

目的比较达芬奇机器人辅助Kasai手术与传统开腹Kasai手术治疗胆道闭锁的早期疗效与安全性。方法回顾性分析2021年1月至2022年6月武汉市儿童医院收治的30例胆道闭锁患儿临床资料,患儿均行Kasai手术,根据手术方式分为达芬奇机器人Kasai手术(robotic portoenterostomy,RP)组和传统开腹Kasai手术(open portoenterostomy,OP)组。收集分析两组患儿一般资料、手术前后生化指标(总胆红素、直接胆红素、谷丙转氨酶和谷草转氨酶)、并发症、住院时间、术后6个月内胆管炎及黄疸清除情况,比较两组患儿短期随访结果。结果RP组9例,其中男8例,女1例;体重5.4(5.0,6.5)kg;日龄65(56,90)d;。OP组21例,其中男13例;女8例;体重4.9(4.5,5.8)kg;日龄59(49,85)d;。两组上述指标差异均无统计学意义(P>0.05)。RP组和OP组术前总胆红素[179.6(116.2,224.5)mmol/L比170.3(129.6,208.2)mmol/L]、术后1周总胆红素[115.0(69.3,143.4)mmol/L比120.3(88.5,160.7)mmol/L]、术前直接胆红素[83.4(79.0,155.7)mmol/L比97.6(82.5,147.4)mmol/L]、术后1周直接胆红素[71.6(47.6,100.2)mmol/L比82.1(64.3,117.5)mmol/L]、术前谷丙转氨酶[175(114,234)U/L比147(94,218)U/L]、术后1周谷丙转氨酶[144(119,310)U/L比183(150,253)U/L]、术前谷草转氨酶[212(164,269)U/L比129(96,157)U/L]、术后1周谷草转氨酶[167(90,191)U/L比120(80,155)U/L]比较,差异均无统计学意义(P>0.05)。各组患儿手术后生化指标对比手术前,除OP组谷丙转氨酶术后升高外,其余均降低,差异均有统计学意义(P<0.05)。RP组和OP组术后住院天数[15(12.5,21.5)d比15(12,17.5)d]、并发症发生率(2/9比3/21)、胆管炎发生率(7/9比15/21)及黄疸清除率(3/9比12/21)比较,差异均无统计学意义(P>0.05)。结论达芬奇机器人Kasai手术与传统开腹Kasai手术治疗胆道闭锁的早期疗效相当。

Objective To compare the early efficacy and safety of Da Vinci robot-assisted Kasai versus traditional open surgery for biliary atresia(BA).Methods From January 2021 to June 2022,retrospective analysis was performed for 9 children undergoing robotic portoenterostomy(RP)and another 21 children open portoenterostomy(OP)within the same period.General profiles,perioperative biochemical parameters,postoperative complications and hospitalization stay were compared.Results In RP group,there were 8 boys and 1 girl with a body weight of 5.4(5.0-6.5)kg and an average age of 65(56-90)day;In OP group,13 boys and 8 girls with a body weight of 4.9(4.5-5.8)kg and an average age of 59(49,85)day.No significant differences existed among the above parameters(P>0.05).In RP and OP groups,preoperative total bilirubin[179.6(116.2-224.5)mmol/L vs.170.3(129.6-208.2)mmol/L],postoperative total bilirubin[115.0(69.3-143.4)mmol/L vs.120.3(88.5-160.7)mmol/L],preoperative direct bilirubin[83.4(79.0-155.7)mmol/L vs.97.6(82.5-147.4)mmol/L],postoperative direct bilirubin[71.6(47.6-100.2)mmol/L vs.82.1(64.3-117.5)mmol/L],preoperative alanine aminotransferase[175(114-234)U/L vs.147(94-218)U/L],postoperative alanine aminotransferase[144(119-310)U/L vs.183(150-253)U/L],preoperative aspartate aminotransferase[212(164-164)U/L vs.129(96-157)U/L]and postoperative aspartate aminotransferase[167(90-191)U/L vs.120(80-155)U/L].There were no differences of statistical significance(P>0.05).Compared with those before operation,the biochemical indexes of children in all groups after operation were decreased except for the increase of alanine aminotransferase after operation in OP group,with statistical significance(P<0.05).Postoperative hospitalization stay[15(12.5-21.5)day vs.15(12-17.5)day],postoperative complication rate(2/9 vs.3/21),cholangitis rate(7/9 vs.15/21)and jaundice clearance(3/9 vs.12/21)showed no inter-group differences of statistical significance(P>0.05).Conclusions Early curative efficacy of Da Vinci robotic surgery and open surgery is comparable for BA.