机器人食管裂孔疝修补术152例临床分析

Clinical analysis of 152 cases of robot-assisted esophageal hiatal hernia repair

目的 探讨机器人食管裂孔疝修补术的安全性和有效性,并结合单中心数据总结经验。方法 回顾性分析2019年12月至2023年11月徐州医科大学附属医院普通外科收治的152例食管裂孔疝病人的临床资料,均由同一团队实施机器人食管裂孔疝修补+Nissen胃底折叠术。采用胃食管反流问卷(GerdQ)评估病人术后症状改善情况;采用累积和分析法(CUSUM)绘制并分析学习曲线。结果 152例病人均顺利完成手术,手术时间为(98.9±38.1)min,术中出血(46.7±19.4)mL,术中均未输血,无中转开放或腹腔镜手术病例,术中均未发生严重并发症。术后住院时间为(2.0±1.2)d,术后无Clavien-Dindo分级≥Ⅲ级的严重并发症发生。术后均完成随访,术后3个月存在吞咽困难5例(3.3%),腹泻4例(2.6%),术后GerdQ评分明显低于术前[(6.4±0.9)分vs.(11.1±3.4)分,P<0.05]。术后3个月无症状及解剖复发。学习曲线的峰值位于第4~5例病人,之后手术时间明显缩短并保持稳定。结论 机器人食管裂孔疝修补术学习曲线短,术中和术后并发症少,短期随访效果良好,是安全可行的手术方式。

Objective To investigate the safety and efficacy of Da Vinci robotic-assisted hiatal hernia repair surgery,and to summarize the experience based on single-center data.Methods The clinical data of 152 patients who underwent robotic-assisted hiatal hernia repair surgery by the same team in the General Surgery Department of the Affiliated Hospital of Xuzhou Medical University from December 2019 to November 2023 were retrospectively analyzed.Improvements in post-operative symptoms were assessed using the Gastroesophageal Reflux Disease Questionnaire(GerdQ).The learning curve was analyzed through the cumulative sum analysis method of operation time(CUSUMOT).Results All 152 patients successfully underwent the surgical procedure,with an operative time of(98.9±38.1)minutes,and intraoperative blood loss of(46.7±19.4)mL.There were no cases requiring blood transfusion,conversion to open or laparoscopic surgery,or serious intraoperative complications.The post-operative hospital stay averaged(2.0±1.2)days,with no occurrences of severe complications classified as Clavien-Dindo grade≥III.All patients completed follow-up:three months post-operation,5 cases(3.3%)experienced dysphagia,4 cases(2.63%)reported diarrhea,and the post-operative GerdQ score significantly decreased compared to pre-operation[(6.4±0.9)vs.(11.1±3.4),P<0.05].There were no symptomatic or anatomical recurrences three months post-operation.The peak of the learning curve was observed between the 4th and 5th patients,after which the operative time substantially decreased and remained stable.Conclusion The learning curve for Da Vinci robotic-assisted hiatal hernia repair surgery is short.The procedure is safe and effective.