机器人辅助腹腔镜下小儿肾上腺区肿物切除术6例报告

Application of Robot-assisted Laparoscopic Adrenalectomy for Adrenal Region Masses in Children: Report of 6 Cases

目的探讨机器人辅助腹腔镜下小儿肾上腺区肿物切除术的安全性和有效性。方法2019年10月~2022年3月我们采用达芬奇机器人辅助腹腔镜下切除6例小儿肾上腺区肿物。取健侧60°卧位,采用两机械臂操作,视情况增加辅助操作孔。钝锐结合显露肿瘤后注意辨识肿物滋养血管,采用丝线或生物夹夹闭离断肿瘤血管;充分游离肿瘤,将整个肿瘤完整切除。较小标本经稍扩大操作孔取出,较大标本经下腹部另外切口取出。结果6例手术均顺利完成,无一例中转开放手术。手术时间90~240 min,平均133.3 min。出血量15~50 ml,平均31.7 ml。术后2例未放置引流管,其余4例放置引流管4~8 d,平均5.5 d。术后住院5~15 d,平均8.7 d。除1例术后出血,其余患儿均无并发症发生。6例随访10~24个月,平均16.7月,复查CT无肿瘤复发。结论机器人辅助腹腔镜下小儿肾上腺区肿物切除术安全,效果满意。

Objective To explore the safety and efficiency of robot-assisted laparoscopic resection of pediatric adrenal region masses.Methods Six cases with adrenal region mass underwent robot-assisted laparoscopic adrenalectomy(RALA)from October 2019 to March 2022 in our hospital by using the da Vinci Robotic Surgery System.The patient was routinely placed in the 60°position on the healthy side.Two robotic arms were used to operate,and additional auxiliary operation holes were added as needed.The tumor was revealed by the combination of sharp and blunt separation,and the tumor trophoblastic vessels were identified.The tumor vessels were isolated by clamping with silk wire or biological clips.The tumor was fully freed and excised completely.Smaller specimens were removed by a slightly enlarged operation hole,and larger specimens were removed by another incision in the lower abdomen.Results All the 6 cases of procedures were successfully performed without conversion to open surgery.The operative duration was 90-240 min(mean,133.3 min),and the blood loss was 15-50 ml(mean,31.7 ml).In 2 cases,the drainage tube was not placed.In the remaining 4 cases,the indwelling time of the drainage tube after surgery was 4-8 d(mean,5.5 d).The postoperative hospital stay was 5-15 d(mean,8.7 d).There were no complications except for one patient with postoperative bleeding.All the patients were followed up for 10-24 months(mean,16.7 months).CT examinations showed no recurrence of tumors.Conclusion Robotic-assisted laparoscopic resection of pediatric adrenal region masses is safe with satisfactory results.