da Vinci机器人辅助腹腔镜Soave拖出术治疗先天性巨结肠症

Robotic-assisted Soave Pull-through for Hirschsprung's Disease in Infants

目的探讨daVinci机器人辅助先天性巨结肠Soave拖出术的可行性。方法2015年5～8月行daVinci机器人辅助巨结肠Soave拖出术3例。采用四孔技术，调整患儿体位和trocar位置后，完成daVinci机器人与患儿的对接。肠壁浆肌层活检明确病变范围，单级电凝或超声刀游离直肠、乙状结肠系膜。解除机器人与患儿的对接，转至会阴部操作。电凝分离直肠黏膜达腹膜返折水平，采用改进的Soave技术进行吻合。结果移行区1例位于直肠，1例位于直肠乙状结肠交界处，1例位于乙状结肠上段。手术时间分别为160、170、200min，无术中并发症。住院时间分别为7、7、14d。3例分别随访35、65、88d，1例患儿因吻合口轻度狭窄需每日扩肛，持续1个月后好转，无小肠结肠炎表现。结论daVinci机器人手术系统可安全地应用于婴幼儿巨结肠Soave拖出手术，更清晰地显示系膜血管和盆腔细微的组织结构，操作灵巧，有效避免副损伤。

Objective To evaluate the feasibility of laparoscopic robotic-assisted Soave pull-throUgh for Hirschsprung＇ disease in infants by using the da Vinci robotic system. Methods From May to August 2015, 3 infants diagnosed as having Hirschsprung＇ s disease underwent robotic-assisted Soave pull-through by using the da Vinci surgical system. A four-trocar technique was used. After proper adjustment of patient＇ s position and trocar＇ s placement, the patient was matched with the robotic system. Seromuscular colonic biopsy was conducted to clarify the lesion＇ s extent. The rectum and the mesosigmoid membrane were mobilized with monopolar electrocoagulation or ultrasonic knife. Then the robotic system was disconnected with the patient to start performance on the perineal region. The rectal mucosa dissected to the peritoneal fold with electrocoagulation and an anastomosis was conducted by using the Soave pull-through technique. Results The transitional zone was located at the rectum in 1 case, at the rectosigmoid colon in 1 case, and at the descending colon in 1 case. The operative time was 160 min, 170 min, and 200 min, respectively. No intraoperative complications happened. The length of hospital stay was 7 days, 7 days, and 14 days, respectively. Follow-ups lasted for 35 days, 65 days, and 88 days. One patient required anorectal dilation for 1 month because of mild anastomotic stricture. No postoperative cntcrocolitis occurred during follow-ups. Conclusions The da Vinci surgical system can be safely and successfully used in Soave-type resection and pull-through procedure in infants. Robotic technology provides superior dexterity and visualization, thus eliminating the risk of secondary injury.