经脐单孔加一达芬奇机器人在儿童先天性胆总管囊肿手术中应用观察

The application of transumbilical single incision plus one robotic‐assisted surgery in choledochal cyst excision and hepaticojejunostomy in children

本文探讨并总结经脐单孔加一达芬奇机器人在儿童先天性胆总管囊肿根治手术中应用的经验技巧。回顾性分析2020年6—12月,在福建省立医院小儿外科诊断为先天性胆总管囊肿并进行手术治疗的10例患儿的临床资料,其中患儿年龄为2~8(4.6±1.7)岁;体重12.3~25.0(17.1±3.8)kg,Todani分型为Ⅰ型6例,Ⅳ4例。临床表现:无症状4例,腹痛3例,腹痛伴有黄疸3例。术后予以门诊随访。结果10例经脐单孔加一达芬奇机器人先天性胆总管囊肿根治性切除+肝总管空肠Roun‑en‑Y吻合术均获得成功,无中转开放手术。手术时间:204~227(220.0±7.2)min;无术中输血,术中出血量6~9(7.67±0.86)ml;禁食时间2~3(2.30±0.48)d;住院时间4~6(4.7±0.7)d,医疗总费用4~6(5.30±0.42)万元。术后随访3~6个月,患儿未见发生胆汁反流性胃炎及胆管炎等早期并发症。术后3个月复查消化系彩超,患儿肝总管及肝内胆管无扩张。总之,经脐单孔加一达芬奇机器人可达到常规达芬奇机器人手术相同的效果,脐部切口更加隐蔽美观,该术者需积累手术经验、增加熟练程度方可安全应用。

To explore the effectiveness and summarize the experiences of transumbilical single incision plus one robotic-assisted surgery surgery in the treatment of pediatric choledochal cyst.We retrospectively reviewed the medical records of 10 children who underwent choledochal cyst excision and hepaticojejunostomy from June to December 2020 at Fujian Provincial Hospital.The mean age was(4.6±1.7)years(range from 2 years to 8 years).The mean weight was(17.1±3.8)kg(range from 12.3 kg to 25.0 kg).The Todani classifications were type I(n=6)and typeⅣ(n=4).The clinical symptoms were asymptomatic(n=4),abdominal pain(n=3),and abdominal pain with jaundice(n=3).Ten cases of transumbilical SILS+1 robotic-assisted choledochal cyst excision and hepaticojejunostomy were completed successfully.The average duration of operation was 204-227 min((220.0±7.2)min),the mean intraoperative bleeding was(7.67±0.86)ml(range,6-9 ml)without blood transfusion,average fasting time was(2.30±0.48)days(range,2-3 days),the average hospitalization time was(4.70±0.67)days(range,4-6 days)and the medical expense was(5.30±0.42)ten thousand yuan(range,4-6 ten thousand yuan).Ten patients did not develop early complications such as acute cholangitis,ranging from 3 months to 6 months.Ultrasonography showed no dilation of ductuli hepaticus communis and intrahepatic bile duct occurred at the third month after surgery.With the development of minimally invasive techniques and enhanced recovery,the da Vinci robotic surgical system will be extensively used.Transumbilical SILS+1 robotic-assisted surgery has equal effect with routine robotic-assisted surgery.The incision is more subtle and excellent,but the operation should be taken by sophisticated surgeon.