机器人辅助腹腔镜儿童食管裂孔疝手术单中心经验

Single-center experience of robotic-assisted laparoscopic pediatric hiatal hernia surgery

目的总结机器人辅助腹腔镜手术治疗儿童食管裂孔疝单中心病例治疗经验。方法2022年2月~2023年2月期间收治的食管裂孔疝患儿6例,行机器人辅助腹腔镜治疗,6例患儿均采取裂孔修补+Nissen胃底折叠抗反流手术。观察病人的手术时间、术中出血量、胃肠功能恢复时间、术后住院时间、术后并发症发生情况,并随访观察术后恢复情况,如呕吐、吞咽困难、反流复发等。结果所有患儿均顺利进行了机器人辅助腹腔镜手术。术中出血(10±5)ml,手术时间(150±30)分钟,肠胃功能恢复时间(12±4)小时,术后住院时间(5±2)天。所有患儿均未发生切口感染,术中、术后均未输血。术后随访2~13个月,术后并发食管狭窄致吞咽困难1例,造影发现术后出现了食管下段狭窄,于术后5天进行球囊扩张1次,吞咽恢复正常,现术后随访12个月,患儿食管狭窄症状明显消失。1例术后胃食管反流,使用了止酸药物治疗,反流症状在2周内消失,停止用药。无复发疝、气胀综合征和二次手术患儿。无食管穿孔、迷走神经损伤、气胸、感染等并发症,无入住ICU,无死亡。结论儿童机器人辅助腹腔镜食管裂孔疝修补术和腹腔镜食管裂孔疝修补术的效果相似,但对需要精细解剖及减少复杂病例复发可能更具优势;掌握手术技巧,可能会对提高治疗效果减少并发症有利;机器人手术学习曲线可更短更快。

Objective To summarize the experience of robot-assisted laparoscopic surgery for single-center cases of hiatal hernia in children.Methods The clinical data of 6 children with Davinci robot-assisted treatment of children with hiatal hernia who were admitted to the Pediatric Surgery Department of the First Affiliated Hospital of Gannan Medical College from February 2022 to February 2023 were retrospectively analyzed.All the 6 cases underwent hiatus repair and Nissen fundus folding operation.The operation time,intraoperative blood loss,gastrointestinal function recovery time,postoperative hospital stay,postoperative complications,and postoperative recovery,such as vomiting,reflux recurrence,were followed up.Results All 6 patients underwent robotic surgery successfully.The intraoperative blood loss was(10±5)ml,the operation time was(150±30)min,and the gastrointestinal recovery time was(12±4)h.The postoperative hospital stay was(5±2)days.No incision infection occurred in any of the children,and no blood transfusion occurred during or after the operation.The postoperative follow-up was 2 to 13 months,and the postoperative esophageal stenosis caused dysphagia in 1 case.The angiography found postoperative lower esophageal stenosis,and the balloon dilation was performed once 5 days after the operation,and the swallowing returned to normal.Now,the postoperative follow-up was 12 months,and the symptoms of esophageal stenosis disappeared obviously.One case of gastroesophageal reflux after operation was treated with antiacid drugs,and the reflux symptoms disappeared within 2 weeks,so the drugs were stopped.There were no children with recurrent hernia,gas-bloat syndrome and secondary surgery.There were no complications such as esophageal perforation,vagus nerve injury,pneumothorax,infection,admission to ICU or death.Conclusion The effects of robotic-assisted and laparoscopic esophageal hiatal hernia repair in children are similar,but they may be more advantageous in cases that require fine anatomy and reduce recurrence in complex cases;mastering surgical skills may be beneficial to improve treatment effects and reduce complications.The learning curve for robotic surgery can be shorter and faster.