达芬奇机器人辅助腔镜技术在小儿胸科手术中的应用

Application of Da Vinci robot-assisted endoscope during pediatric thoracic surgery

目的探讨达芬奇机器人辅助腔镜技术在小儿胸部疾病中应用的可行性、实用性及安全性。方法收集浙江大学医学院附属儿童医院胸外科2020年5月至2020年10月经机器人辅助腔镜技术治疗的71例患儿的临床资料。其中,男44例,女27例;患儿中位年龄为1岁4个月,范围为7个月11 d至14岁;患儿中位体重为11.5 kg,范围为7.2~93.5 kg。手术种类包括肺叶或肺段切除术50例,纵隔肿瘤切除术10例,食道裂孔疝修补联合抗反流术2例,动脉导管未闭结扎术8例,膈肌折叠术1例。结果除1例(1.4%,1/71)左肺下叶切除术因术中暴露困难中转开胸,余70例均在机器人辅助下顺利完成手术;全组无死亡病例。患儿平均手术时间为75 min,范围为30~165 min。患儿术中平均出血量为3.6 ml,范围为1.0~30.0 ml,无患儿需输血。患儿拔除胸腔引流的平均时间为1.5 d,范围为1.0~25.0 d。患儿平均住院时间为6.5 d,范围为4.0~30.0 d。术中、术后2例(2.8%,2/71)出现并发症,1例为前纵隔的淋巴管瘤,术后出现淋巴漏,保守治疗后好转;1例为动脉导管未闭,术后出现声音嘶哑、喝水呛咳的喉返神经损伤的症状,保守治疗1个月后症状慢慢好转。结论机器人辅助腔镜技术可以用于大部分小儿胸外科手术,而且创伤小、恢复快、安全可行。

Objective To explore the feasibility,practicability and safety of Da Vinci robot-assisted endoscopy in children with thoracic diseases.Methods From May 2020 to October 2020,71 patients underwent robot-assisted endoscopy.The median age was 16 years(7 months 11 days to 14 years)and the median weight 11.5(7.2-93.5)kg.The procedures included lobectomy(n=50),mediastinal tumor resection(n=10),esophageal hiatal hernia repair plus anti-reflux surgery(n=2),patent ductus arteriosus ligation(n=8)and diaphragmatic folding(n=1).Results Except for 1 case(1.4%,1/71)of converting left lower lobe resection into thoracotomy due to difficult intraoperative exposure.The remainders completed robot-assisted operations successfully.No intraoperative death occurred.The average operation time was 75 min,ranging from 30 to 165 min.The average amount of intraoperative bleeding was 3.6 mL,ranging from 1 to 30 ml.There was no need for blood transfusion.The average duration of thoracic drainage was 1.5 days,ranging from 1 to 25 days.The average hospital stay was 6.5 days,ranging from 4 to 30 days.Intra/postoperative complications occurred(n=2,2.8%).Drainage tube was retained for 1.5 days postoperatively and discharged from hospital at Day 6.5 postoperatively.Conclusions Robot-assisted endoscopy is ideal for most pediatric thoracic operations.And it offers the advantages of minimal trauma,safety and rapid recovery.