机器人手术与腹腔镜手术治疗小儿胆总管囊肿中短期随访的对比研究

Short/medium-term follow-ups of robotic surgery versus laparoscopy for pediatric choledochal cysts

目的探讨达芬奇机器人手术相较于腹腔镜手术在治疗小儿胆总管囊肿术中及术后中短期随访中的不同情况。方法回顾性分析2019年1月至2022年4月于四川大学华西医院接受腹腔镜手术及机器人手术治疗的173例胆总管囊肿患儿的临床资料,按手术方式将患儿分为腹腔镜组(63例)和机器人组(110例)。腹腔镜组男12例,女51例;年龄为36(12,48)个月;机器人组男29例,女81例;年龄为36(24,60)个月。对比分析两种术式手术时间、术后住院时间、中短期手术并发症情况及二次手术情况。计量资料的比较采用Mann-whitney U检验,计数资料的比较采用χ^(2)检验或Fisher's精确检验。结果除腹腔镜组4例中转开放手术(3例因囊肿与周围组织粘连严重,1例因出血严重)外,其余患儿均顺利完成手术。腹腔镜组手术时间为240(196,278)min,大于机器人组的180(157,214)min(Z=-4.96,P<0.001);腹腔镜组术后住院时间为8(7,9)d,大于机器人组的7(6,8)d(Z=-0.28,P=0.006)。所有患儿随访时间为21(14,29)个月。随访期间,共11例(6.4%,11/173)患儿术后发生并发症。胆道并发症方面,腹腔镜组胆管吻合口狭窄发生6例(9.5%,6/63),机器人组胆管吻合口狭窄发生1例(0.9%,1/110),组间差异有统计学意义(P=0.010)。肠道并发症方面,腹腔镜组肠梗阻发生2例,机器人组1例。腹腔镜组行二次手术6例(9.5%,6/63),机器人组3例(2.7%,3/110)。结论达芬奇机器人手术系统辅助儿童胆总管囊肿切除术相较于腹腔镜手术用时短,在中短期随访中,机器人手术并发症及二次手术率更低,值得临床推广。

Objective To explore the applications of Da Vinci robotic surgical system versus laparoscopic surgery for pediatric choledochal cysts during surgery during postoperative medium/short-term follow-ups.Methods A retrospective analysis was performed for clinical data of 173 children with choledochal cysts undergoing laparoscopic and robot-assisted surgery from January 2019 to April 2022.They were assigned into laparoscopic group(n=63)and robot-assisted group(n=110).The laparoscopic group consisted of 12 boys and 51 girls with an average age of 36(12-48)months;robot-assisted group included 29 boys and 81 girls with an average age of 36(24-60)months.Operative duration,postoperative hospital stay,short/medium-term postoperative complications and incidences of secondary surgeries were compared between two groups.Mann-Whitney U test was utilized for comparing measurement data;χ^(2) or Fisher's exact test for comparing count data.Results Except for 4 cases in laparoscopic group converting into open surgery due to severe cyst adhesion to surrounding tissues(n=3)and massive hemorrhage(n=1),all other procedures were successfully completed.Operative duration was significantly longer in laparoscopic group than that in robot-assisted group with a significant difference[240(196-278)vs 246(197-280)min,Z=-4.96,P<0.001].Postoperative hospital stay was significantly longer in laparoscopic group than that in robot-assisted group with a significant difference[8(7-9)vs 7(6-8)day,Z=-0.28,P=0.006].During a follow-up period of 21(14-29)months,11 children(6.4%,11/173)experienced postoperative complications.The rate of biliary anastomotic stenosis was 9.5%(6/63)in laparoscopic group and 0.9%(1/110)in robot group with a statistically significant(P=0.010).The rate of biliary fistula was 3.2%(2/63)in laparoscopic group and 0 in robot group.The rate of cholangitis was 1.6%(1/63)in laparoscopic group and 0 in robot group.The rate of intestinal obstruction was 2.6%(2/76)in laparoscopic group and 0.9%(1/110)in robot group.The rate of re-operation was 9.5%(6/63)in laparoscopic group and 2.7%(3/110)in robot group.No significant inter-group difference existed(P>0.05).Conclusions Compared with laparoscopic choledochal cyst resection,the incidence of biliary tract complications and the rate of switching to open laparotomy are lower for Da Vinci robotic surgical system.No significant difference exists in intestinal complications between two surgical approaches.