Chen Di-Xiang, Wang Shan-Jie, Jiang Ya-Nan, Yu Mu-Chuan, Fan Jun-Zhen, Wang Xian-Qiang
Department of Pediatrics, PLA General Hospital, Beijing 100853, China.
Department of Hepatobiliary, Sixth People's Hospital of Jinan Affiliated to Jining Medical School, Jinan 250200, Shandong Province, China.
World J Clin Cases. 2019 Apr 6;7(7):872-880. doi: 10.12998/wjcc.v7.i7.872.
Hepatoblastoma (HB) is the most common hepatic malignant tumour in children, accounting for approximately 50%-60% of primary hepatic malignant tumours in children, mostly in children under 3 years old. In Western countries, the incidence of hepatoblastoma is approximately 1-2/100000. Da Vinci surgical system is fast becoming a key instrument in microinvasive surgery. The past decade has seen the rapid development of robot-assisted laparoscopy, which expends many fields including the liver surgery. This paper discusses the significance and feasibility of robot-assisted gallbladder-preserving hepatectomy for treating S5 hepatoblastoma in children. The aim of this essay is to compare the safety and effectiveness of robotic surgery with conventional laparoscopic surgery, and explore the meaning of preservation of the gallbladder by sharing this case.
A 3-year-old child with a liver mass in the 5 segment was treated using the Da Vinci surgical system, and the gallbladder was retained. The child was admitted to the hospital for 20 d for the discovery of the right hepatic lobe mass. Ultrasonography revealed a low echo mass, 46 mm × 26 mm × 58 mm in size, indicating hepatoblastoma in the right lobe, and enhanced computed tomography showed continuous enhancement of iso-low-density lesions with different sizes and nodules and unclear boundaries, without the dilation of the intrahepatic bile duct, no enlargement of the gallbladder, and uniform thickness of the wall. The diagnosis was "liver mass, hepatoblastoma". It was decided to perform S5 liver tumour resection. During surgery, the tumour and gallbladder were isolated first, and the gallbladder could be completely separated from the tumour surface without obvious infiltration; therefore, the gallbladder was preserved. The cutting line was marked with an electric hook. The hepatic duodenal ligament was blocked with a urethral catheter using the Pringle method, and the tumour and part of the normal liver tissue were completely resected with an ultrasound knife along the incision. The hepatic portal interdiction time was approximately 25 min. An abdominal drainage tube was inserted. The auxiliary hole was connected to the lens, and the specimen was removed. The patient's status was uneventful, and the operation time was 166 min. The robotic time was 115 min, and the bleeding amount was approximately 200 mL. In total, 300 mL of red blood cell suspension and 200 mL of plasma were injected. No serious complications occurred. Pathological findings confirmed fetal hepatoblastoma and R0 resection. A gallbladder contraction test was performed two weeks after surgery.
Robot-assisted S5 hepatectomy with gallbladder preservation is safe and feasible for specific patients.
肝母细胞瘤（HB）是儿童最常见的肝脏恶性肿瘤，约占儿童原发性肝脏恶性肿瘤的50%-60%，多见于3岁以下儿童。在西方国家，肝母细胞瘤的发病率约为1-2/10万。达芬奇手术系统正迅速成为微创手术中的关键器械。过去十年，机器人辅助腹腔镜手术发展迅速，其应用范围涵盖包括肝脏手术在内的多个领域。本文探讨机器人辅助保留胆囊肝切除术治疗儿童S5肝母细胞瘤的意义及可行性。本文旨在比较机器人手术与传统腹腔镜手术的安全性和有效性，并通过分享该病例探讨保留胆囊的意义。
一名3岁儿童因肝脏5段肿物，采用达芬奇手术系统进行治疗，并保留了胆囊。该患儿因发现右肝叶肿物入院20天。超声检查显示一低回声肿物，大小为46mm×26mm×58mm，提示右叶肝母细胞瘤，增强CT显示不同大小和结节的等低密度病变持续强化，边界不清，肝内胆管未扩张，胆囊未增大，壁厚度均匀。诊断为“肝脏肿物，肝母细胞瘤”。决定行S5肝肿瘤切除术。手术过程中，先分离肿瘤和胆囊，胆囊可与肿瘤表面完全分离，无明显浸润；因此，保留了胆囊。用电钩标记切割线。采用Pringle法用导尿管阻断肝十二指肠韧带，沿切口用超声刀完整切除肿瘤及部分正常肝组织。肝门阻断时间约25分钟。置入腹腔引流管。辅助孔连接镜头，取出标本。患者情况平稳，手术时间为166分钟。机器人操作时间为115分钟，出血量约200mL。共输注300mL红细胞悬液和200mL血浆。未发生严重并发症。病理结果证实为胎儿型肝母细胞瘤，切缘R0切除。术后两周进行胆囊收缩试验。
机器人辅助保留胆囊S5肝切除术对特定患者安全可行。
