机器人辅助与单孔腹腔镜胆总管囊肿切除术的对比研究

Comparison Between Robot-assisted and Single-port Laparoscopic Resection of Choledochal Cyst

目的探讨机器人辅助腹腔镜胆总管囊肿切除术的临床效果。方法回顾性比较2020年10月~2022年6月我科21例机器人辅助(机器人组)与22例单孔腹腔镜胆总管囊肿切除术(腹腔镜组)的临床资料,比较2组手术时间、术中出血量、术后引流管留置时间、禁食时间、住院时间及手术费用。结果机器人组术中出血量[10.0(8.0,13.0)ml vs.15.0(11.8,18.0)ml,Z=-3.292,P=0.001]、引流管留置时间[5.0(4.5,6.0)d vs.7.0(5.8,8.2)d,Z=-3.256,P=0.001]、禁食时间[4.0(3.0,4.5)d vs.6.0(5.0,7.0)d,Z=-4.348,P=0.000]及住院时间[6.0(6.0,7.0)d vs.8.0(6.0,9.3)d,Z=-3.061,P=0.002]均明显短于腹腔镜组。机器人组手术时间[394.0(305.0,420.0)min vs.351.5(269.3,379.8)min,Z=-2.236,P=0.025]和住院综合费用[(7.92±0.39)万元vs.(3.11±0.30)万元,t=45.386,P=0.000]明显长于/高于腹腔镜组。术后并发症及疼痛评分2组比较无差异无统计学意义(P>0.05)。所有患儿随访4~24个月,中位数13个月,无胆漏、胰漏、吻合口狭窄、胆管炎、胰腺炎、肠梗阻、切口感染和切口疝等并发症发生。结论机器人辅助腹腔镜胆总管囊肿切除术可以达到单孔腹腔镜手术同样的治疗效果。

Objective To investigate the clinical effect of robot-assisted laparoscopic resection of choledochal cyst.Methods Clinical data were retrospectively compared between 21 cases of robot-assisted laparoscopic resection of choledochal cyst(robotic group)and 22 cases of single-port laparoscopic resection of choledochal cyst(laparoscopic group)in our department from October 2020 to June 2022.The duration of surgery,intraoperative blood loss,postoperative drain indwelling time,fasting time,hospital stay,and surgical expenses were compared.Results The intraoperative blood loss[10.0(8.0,13.0)ml vs.15.0(11.8,18.0)ml,Z=3.292,P=0.001],drainage tube indwelling time[5.0(4.5,6.0)d vs.7.0(5.8,8.2)d,Z=-3.256,P=0.001],fasting time[4.0(3.0,4.5)d vs.6.0(5.0,7.0)d,Z=-4.348,P=0.000]and hospital stay[6.0(6.0,7.0)d vs.8.0(6.0,9.3)d,Z=-3.061,P=0.002]in the robotic group were significantly less than those in the laparoscopic group.The operation time[394.0(305.0,420.0)min vs.351.5(269.3,379.8)min,Z=-2.236,P=0.025]and hospitalization costs[(7.92±0.39)ten thousand yuan vs.(3.11±0.30)ten thousand yuan,t=45.386,P=0.000]of the robotic group were significantly longer or higher than those of the laparoscopic group.There were no significant differences in postoperative complications and pain scores between the two groups(P>0.05).All the children were regularly followed up for 4-24 months,with a median of 13 months.There were no complications such as biliary leakage,pancreatic leakage,anastomotic stenosis,cholangitis,pancreatitis,intestinal obstruction,incision infection or incision hernia.Conclusion Robot-assisted laparoscopic resection of choledochal cyst achieves the same treatment effect as single-port laparoscopic surgery.