达芬奇机器人手术治疗儿童胆总管囊肿的初步报告

Preliminary report of robotic surgery for congenital dilatation of bile duct

目的探讨达芬奇机器人在小儿胆总管囊肿治疗上的应用。方法回顾性分析2015年12月到2017年6月在中山大学附属第一医院小儿外科就诊的采用达芬奇机器人行胆总管囊肿手术6例患儿的临床资料。本组男2例，女4例；平均年龄4岁3个月；平均体重15.8 kg。按Todani分型：Ⅰ型5例，Ⅳa型1例。患儿就诊时有腹痛5例，有呕吐3例，有黄疸1例。手术包括胆囊切除、胆总管囊肿切除、肝总管空肠R0-Y吻合术等，其中空肠-空肠吻合在腹腔外进行。2例患儿术中发现副肝管，直径分别约2 mm，予行胆管整形后行胆肠吻合术。结果6例患儿均顺利完成手术，无中转开放手术者。本组平均总手术时间为276 min，平均机器人操作时间为175 min。1例术前有贫血患儿，由于炎症术中渗血明显，予术中输血。所有患儿术后第3～4天开始进食流质，第5～6天正常饮食，引流管拔除时间为术后第4～5天，术后6～7 d予出院，随访至今均无近期或远期并发症出现。结论达芬奇机器人手术可安全有效的应用于治疗儿童先天性胆总管囊肿，是微创外科领域的一个新进展，且患儿术后恢复快、外表美观。

ObjectiveTo explore the application of robotic surgery for choledochal cyst.MethodsSix cases of choledochal cyst were recruited from December 2015 to June 2017.There were 2 boys and 4 girls with a mean age of 51 months and a mean body weight of 15.8 kilograms.The types of choledochal cysts wereⅠ（n=5） and Ⅳa （n=1）. The clinical manifestations included abdominal pain （n=5）, vomiting （n=3） and jaundice （n=1）. Da Vinci Surgical System was utilized for robot-assisted resection of choledochal cyst and hepaticojejunostomy.And jejuno-jejunostomy was performed extracorporeally.Two cases had accessory bile duct during operation and biliary reconstruction was successfully carried under robotic surgery.ResultsAll cases were completed successfully with robotic assistance.The mean total operative duration was 276 min and the mean robotic console operating time 175 min.Feeding resumed partially at 3-4 days and fully at 5-6 days.Discharge occurred at 6-7 days.There were no complications.ConclusionsDa Vinci robotic surgical system is both safe and effective for choledochal cysts.With a rapid recovery, cosmetic outcomes are excellent.