达芬奇机器人辅助小儿胆管扩张症切除单中心200例经验分享

Da Vinci robot assisted choledochal cyst resection in children:experience sharing of 200cases in a single center

目的探讨达芬奇机器人辅助小儿胆管扩张症采用手术切除的临床疗效及经验总结。方法回顾性收集2018年4月至2022年6月期间在四川大学华西医院小儿外科对胆管扩张症采用达芬奇机器人辅助手术切除患儿的临床资料,分析术前、术中及术后随访资料。结果本研究共收集到200例患儿,男54例、女146例,男∶女=1∶2.70,年龄(46±33)个月,体质量(15.77±7.10)kg,主要表现为腹痛136例(68.0%)、黄疸62例(31.0%)、腹部包块23例(11.5%)、腹胀20例(10.0%);囊肿直径(3.46±2.01)cm;囊肿Todani分型Ⅰa型153例,Ⅰc型35例,Ⅱ型1例,Ⅳ型11例。手术时间(179.9±10.3)min,术中补液量(397.4±26.4)mL,术中出血量(21.5±10.9)mL,进食液体饮食时间(3.01±0.35)d、进食固体饮食时间(3.80±0.27)d,术后住院时间(7.44±0.94)d。术中输血4例(2.0%)。术后并发症7例(3.5%),其中胆汁漏2例,不全性肠梗阻2例,吻合口出血1例,均经保守治疗好转;吻合口狭窄1例,重新行Roux-en-Y吻合后恢复;胆袢扭转梗阻1例,重新手术胆袢复位固定后好转。其余病例随访2~50个月,未发生并发症,肝功能均正常。结论从本研究结果看,达芬奇机器人手术系统可以明显降低胆管扩张症患儿采用手术切除的难度,具有安全、切口美观、暴露清晰、恢复快、并发症少等优点。

Objective To explore the clinical efficacy and share the experience of Da Vinci robot assisted choledochal cyst resection in children.Method The data of children including preoperative,intraoperative,and postoperative details who underwent Da Vinci robot assisted choledochal cyst resection in the Department of Pediatric Surgery,West China Hospital of Sichuan University from April 2018 to June 2022 were collected and analyzed.Results A total of 200 patients were collected in this study,54 of whom were males and 146 were females.The male to female was 1∶2.70.The age was(46±33)months and the body weight was(15.77±7.10)kg.The main symptoms were abdominal pain(136 cases,68.0%),jaundice(62 cases,31.0%),abdominal distension(20 cases,10.0%),and abdominal mass(23 cases,11.5%).The diameter of cyst was(3.46±2.01)cm.There were 153 cases of typeⅠa,35 cases of typeⅠc,1 case of typeⅡ,and 11 cases of typeⅣ.The operation time was(179.9±10.3)min,the intraoperative fluid infusion was(397.4±26.4)mL,the intraoperative blood loss was(21.5±10.9)mL,the liquid intake time was(3.01±0.35)d,the solid intake time was(3.80±0.27)d,and the postoperative hospitalization time was(7.44±0.94)d.The intraoperative blood transfusion was performed in 4 cases(2.0%).There were 7 cases(3.5%)of postoperative complications,including 2 cases of biliary leakage,2 cases of incomplete intestinal obstruction,and 1 case of anastomotic bleeding,which were improved by conservative treatment.Anastomotic stenosis occurred in 1 case,and the Roux-en-Y anastomosis was performed again.Biliary loop torsion obstruction occured in 1 case,which received reoperation restoring the biliary loop and closing the mesangial fissure.Conclusions From the results of this study,Da Vinci robotic surgical system can obviously reduce the difficulty of choledochal cyst resection in children.It has the advantages of safe,beautiful incision,clear exposure,rapid recovery,and less complications.