达芬奇机器人系统辅助小儿胆总管囊肿全切除 10 例报告
Total robot-assisted choledochal cyst excision using da Vinci surgical system in pediatrics: Report of 10 cases.
机构信息
Department of pediatric surgery, West China hospital, Sichuan University, China.
Department of pediatric surgery, West China hospital, Sichuan University, China.
出版信息
J Pediatr Surg. 2021 Mar;56(3):553-558. doi: 10.1016/j.jpedsurg.2020.07.019. Epub 2020 Jul 28.
BACKGROUND
The robotic surgery has been proposed as another adjunct for pediatric minimal surgery for choledochal cyst. However, the Roux-en-Y jejunal limb in most reports on robot-assist choledochal cyst resection is usually created extracorporeally in children. The pediatric surgery team of West China Hospital of Sichuan University had completed 10 cases of total robot-assisted choledochal cyst resection. The aim of this current study was to present our initial experience in total robot-assisted surgery and discuss the technical points.
METHODS
Between January 2015 and February 2020, patients with choledochal cysts treated with total robot-assisted procedures were retrospectively analyzed. The data collected included demographic information of all patients, type and size of cyst, operative details and postoperative outcomes.
RESULTS
A total of 10 episodes of patients were enrolled in the study. The median age of the patient was 69.50 months with a mean weight of 20.50 kg. The most common symptoms were abdominal pain, vomiting, and jaundice (60%, 30%, and 30%, respectively). The types of cyst included 2 Ia, 7 Ic and 1 IV. The mean operation time was 218.70 min and there were no red blood cell transfusion and conversion in the 10 patients. The mean time to taking water was 3.37 days and mean time to starting liquid diet was 3.77 days. And the average length of postoperative hospital stay was 7.92 days. All 10 patients were eventually discharged and made uneventful recoveries after the operation.
CONCLUSIONS
Total robot-assisted choledochal cyst excision comprising Roux-en-Y limb formation, excision of the cyst and hepaticojejunostomy appears to be safe and feasible in pediatrics. Our initial experience shows that it is recommended to perform total robot-assisted choledochal cyst excision for patients over 4 years while a Roux-en-Y jejunojejunal anastomosis is recommended to be performed extracorporeally by prolapsing the jejunum out of abdominal cavity for patients under 4 years old.
LEVEL OF EVIDENCE
Treatment Study.
TYPE OF STUDY
Retrospective Study.
背景
机器人手术已被提议作为小儿胆管囊肿微创手术的另一种辅助手段。然而，在大多数关于机器人辅助胆管囊肿切除的报告中，在儿童中通常在体外创建 Roux-en-Y 空肠襻。四川大学华西医院小儿外科团队已完成 10 例全机器人辅助胆管囊肿切除。本研究旨在介绍我们在全机器人手术中的初步经验，并讨论技术要点。
方法
回顾性分析 2015 年 1 月至 2020 年 2 月期间接受全机器人手术治疗的胆管囊肿患者。收集的资料包括所有患者的人口统计学信息、囊肿的类型和大小、手术细节和术后结果。
结果
共纳入 10 例患者。患者的中位年龄为 69.50 个月，平均体重为 20.50kg。最常见的症状是腹痛、呕吐和黄疸（分别为 60%、30%和 30%）。囊肿类型包括 2 例 Ia 型、7 例 Ic 型和 1 例 IV 型。平均手术时间为 218.70 分钟，10 例患者均未输血和中转开腹。饮水时间平均为 3.37 天，开始液体饮食时间平均为 3.77 天。术后平均住院时间为 7.92 天。所有 10 例患者最终均出院，术后恢复顺利。
结论
全机器人辅助胆管囊肿切除术包括 Roux-en-Y 空肠襻的形成、囊肿切除和胆肠吻合术，在儿科中似乎是安全可行的。我们的初步经验表明，对于 4 岁以上的患者，建议行全机器人辅助胆管囊肿切除术，对于 4 岁以下的患者，建议将空肠从腹腔内拖出行体外 Roux-en-Y 空肠空肠吻合术。
证据水平
治疗研究。
研究类型
回顾性研究。
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