Lin S, He S H, Li L Z, Li Y, Xu D
Provincial Clinical Medical College of Fujian Medical University, Department of Pediatric Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.
Zhonghua Yi Xue Za Zhi. 2021 Nov 30;101(44):3655-3659. doi: 10.3760/cma.j.cn112137-20210406-00819.
To explore the effectiveness and summarize the experiences of transumbilical single incision plus one robotic-assisted surgery surgery in the treatment of pediatric choledochal cyst. We retrospectively reviewed the medical records of 10 children who underwent choledochal cyst excision and hepaticojejunostomy from June to December 2020 at Fujian Provincial Hospital. The mean age was (4.6±1.7) years (range from 2 years to 8 years). The mean weight was (17.1±3.8) kg (range from 12.3 kg to 25.0 kg). The Todani classifications were type I (=6) and type Ⅳ(=4).The clinical symptoms were asymptomatic (=4), abdominal pain (=3), and abdominal pain with jaundice (=3). Ten cases of transumbilical SILS+1 robotic-assisted choledochal cyst excision and hepaticojejunostomy were completed successfully. The average duration of operation was 204-227 min ((220.0±7.2) min), the mean intraoperative bleeding was (7.67±0.86) ml (range, 6-9 ml) without blood transfusion, average fasting time was (2.30±0.48) days (range, 2-3 days), the average hospitalization time was (4.70±0.67) days (range, 4-6 days) and the medical expense was (5.30±0.42) ten thousand yuan (range, 4-6 ten thousand yuan). Ten patients did not develop early complications such as acute cholangitis, ranging from 3 months to 6 months. Ultrasonography showed no dilation of ductuli hepaticus communis and intrahepatic bile duct occurred at the third month after surgery. With the development of minimally invasive techniques and enhanced recovery, the da Vinci robotic surgical system will be extensively used. Transumbilical SILS+1 robotic-assisted surgery has equal effect with routine robotic-assisted surgery. The incision is more subtle and excellent, but the operation should be taken by sophisticated surgeon.
探讨经脐单孔加单机器人辅助手术治疗小儿先天性胆管囊肿的疗效并总结经验。回顾性分析2020年6月至12月在福建省立医院接受胆管囊肿切除及肝管空肠吻合术的10例患儿的病历资料。平均年龄为(4.6±1.7)岁(范围2岁至8岁)。平均体重为(17.1±3.8)kg(范围12.3kg至25.0kg)。Todani分型为Ⅰ型(=6例)和Ⅳ型(=4例)。临床症状为无症状(=4例)、腹痛(=3例)、腹痛伴黄疸(=3例)。成功完成10例经脐单孔腹腔镜下单机器人辅助胆管囊肿切除及肝管空肠吻合术。平均手术时间为204～227分钟((220.0±7.2)分钟)，术中平均出血量为(7.67±0.86)ml(范围6～9ml)，均未输血，平均禁食时间为(2.30±0.48)天(范围2～3天)，平均住院时间为(4.70±0.67)天(范围4～6天)，医疗费用为(5.30±0.42)万元(范围4～6万元)。10例患者均未发生急性胆管炎等早期并发症，随访3个月至6个月。术后3个月超声检查显示肝总管及肝内胆管无扩张。随着微创技术的发展和加速康复理念的推广，达芬奇机器人手术系统将得到更广泛的应用。经脐单孔腹腔镜下单机器人辅助手术与常规机器人辅助手术疗效相当。切口更隐蔽美观，但手术应由经验丰富的外科医生操作。
