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胆管修复的新时代:机器人辅助与腹腔镜胆肠吻合术。

A New Era of Bile Duct Repair: Robotic-Assisted Versus Laparoscopic Hepaticojejunostomy.

机构信息

Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico.

Department of General Surgery, Hospital Sedna, Mexico City, Mexico.

出版信息

J Gastrointest Surg. 2019 Mar;23(3):451-459. doi: 10.1007/s11605-018-4018-0. Epub 2018 Nov 6.

Abstract

BACKGROUND

Despite scientific evidence of the safety, efficacy, and in some cases superiority of minimally invasive surgery in hepato-pancreato-biliary procedures, there are scarce publications about bile duct repairs. The aim of this study was to compare the outcomes of robotic-assisted surgery versus laparoscopic surgery on bile duct repair in patients with post-cholecystectomy bile duct injury.

METHODS

This is a retrospective comparative study of our prospectively collected database of patients with bile duct injury who underwent robotic or laparoscopic hepaticojejunostomy.

RESULTS

Seventy-five bile duct repairs (40 by laparoscopic and 35 by robotic-assisted surgery) were treated from 2012 to 2018. Injury types were as follows: E1 (7.5% vs. 14.3%), E2 (22.5% vs. 14.3%), E3 (40% vs. 42.9%), E4 (22.5% vs. 28.6%), and E5 (7.5% vs. 0), for laparoscopic hepaticojejunostomy (LHJ) and robotic-assisted hepaticojejunostomy (RHJ) respectively. The overall morbidity rate was similar (LHJ 27.5% vs. RHJ 22.8%, P = 0.644), during an overall median follow-up of 28 (14-50) months. In the LHJ group, the actuarial primary patency rate was 92.5% during a median follow-up of 49 (43.2-56.8) months. While in the RHJ group, the actuarial primary patency rate was 100%, during a median follow-up of 16 (12-22) months. The overall primary patency rate was 96% (LHJ 92.5% vs. RHJ 100%, log-rank P = 0.617).

CONCLUSION

Our results showed that the robotic approach is similar to the laparoscopic regarding safety and efficacy in attaining primary patency for bile duct repair.

摘要

背景

尽管微创外科在肝胆胰手术中具有安全性、有效性,且在某些情况下具有优越性,但关于胆管修复的文献却很少。本研究旨在比较机器人辅助手术与腹腔镜手术治疗胆囊切除术后胆管损伤患者胆管修复的结果。

方法

这是一项回顾性比较研究,我们对 2012 年至 2018 年期间接受机器人或腹腔镜胆肠吻合术的胆管损伤患者的前瞻性数据库进行了研究。

结果

共治疗了 75 例胆管修复(腹腔镜 40 例,机器人辅助手术 35 例)。损伤类型如下:E1(7.5%比 14.3%)、E2(22.5%比 14.3%)、E3(40%比 42.9%)、E4(22.5%比 28.6%)和 E5(7.5%比 0%),分别为腹腔镜胆肠吻合术(LHJ)和机器人辅助胆肠吻合术(RHJ)。总的发病率相似(LHJ 27.5%比 RHJ 22.8%,P=0.644),总的中位随访时间为 28(14-50)个月。在 LHJ 组中,中位随访 49(43.2-56.8)个月时,最初通畅率为 92.5%。而在 RHJ 组中,中位随访 16(12-22)个月时,最初通畅率为 100%。总的最初通畅率为 96%(LHJ 92.5%比 RHJ 100%,对数秩 P=0.617)。

结论

我们的结果表明,机器人方法在实现胆管修复的最初通畅方面与腹腔镜方法相似,具有安全性和有效性。

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