小儿达芬奇机器人手术中转原因分析及预防策略:单中心581例

Reasons and preventive strategies of conversions into open surgery during pediatric Da Vinci robotic surgery:a report of 581 cases at a single center

目的探讨小儿达芬奇机器人手术中转原因并提出预防策略。方法收集华中科技大学同济医学院附属武汉儿童医院2020年10月至2022年12月581例单一疾病达芬奇机器人手术患儿的临床资料,其中男325例,女256例;年龄为(4.00±3.52)岁,年龄范围为1 d至16岁10个月,其中新生儿11例,婴儿145例,幼儿132例,学龄前期141例,学龄期137例,青春期15例;身高为(97.65±28.11)cm,范围是45.00~175.00 cm;体重为(17.11±11.22)kg,体重范围是2.00~67.00 kg。根据患儿的年龄和病变部位等情况选择戳孔布局为直线型布局、扇形布局或者三角形布局,分析比较手术时间,术中出血量,中转率等。计数资料进行χ2检验,计量资料进行t检验。结果581例患儿无围手术期死亡病例,手术时间为(186.76±94.81)min,中位术中出血量为5(5,10)ml,范围是1~300 ml,其中7例术中中转开放,中转原因包括侵犯周围重要组织器官3例(分别为肋骨、降主动脉、气管),操作空间狭小2例,术中出血2例。患儿各年龄段中转率差异无统计学意义(χ2=1.18,P=0.947)。结论小儿达芬奇机器人手术中转最常见原因为侵犯周围重要组织器官、操作空间狭小及术中出血,术前准确评估患儿自身空间、病变的范围、与周围组织关系、血供来源及是否合并有感染是降低小儿达芬奇机器人手术中转率的关键。

Objective To explore the reasons of conversions into open procedure during pediatric Da Vinci robot surgery(DVRS)and to propose preventive strategies.Methods From October 2020 to December 2022,the relevant clinical data were retrospectively reviewed for 581 children of a single disease undergoing DVRS.There were 325 boys and 256 girls with an average age of(4.00±3.52)years and an age range of 1 day to 16 years and 10 months.There were 11 neonates,145 infants,132 toddlers,141 preschoolers,137 school-age children and 15 adolescents.Height(body length)was(97.65±28.11)(45.00-175.00)cm and average weight(17.11±11.22)(2.00-67.00)kg.According to patient age and lesion location,puncture layout was selected as linear,fan-shaped or triangular.Operative duration,intraoperative volume of blood loss and conversion rate were compared.Results There was no perioperative mortality.Operative duration was(186.76±94.81)min and intraoperative volume of blood loss(5,10)(1-300)ml.Among them,7 cases were converted into open surgery.The reasons for conversion included invasion of important surrounding tissues and organs(ribs,descending main artery,trachea)(n=3),limited operating space(n=2)and intraoperative hemorrhage(n=2).No statistically significant difference existed in transition rate among different age groups(χ2=1.18,P=0.947).Conclusion Pediatric DVRS is feasible.The most common reasons for conversions into open surgery are invasion of important surrounding tissues and organs,limited operating space and intraoperative hemorrhage.Accurately assessing patient's own space,lesion range,relationship with surrounding tissues,blood supply sources and controlling concurrent infectionare essential for lowering the conversion rate of pediatric DVRS.