Bai Dou-Sheng, Jin Sheng-Jie, Xiang Xiao-Xing, Qian Jian-Jun, Zhang Chi, Zhou Bao-Huan, Jiang Guo-Qing
Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, Jiangsu, China.
Department of Digestive Diseases, Clinical Medical College, Yangzhou University, Yangzhou, China.
Updates Surg. 2022 Oct;74(5):1773-1780. doi: 10.1007/s13304-022-01236-2. Epub 2022 Jan 7.
Robotic surgery has been widely accepted in many kinds of surgical procedures. Little is known about clinical effects of robotic-assisted splenectomy and azygoportal disconnection (RSD) for gastroesophageal variceal bleeding and secondary hypersplenism owing to cirrhotic portal hypertension. The aim of this study was to evaluate whether RSD is feasible and safe for patients with cirrhotic portal hypertension and whether RSD is superior to laparoscopic splenectomy and azygoportal disconnection (LSD). We retrospectively investigated the clinical effects of 50 patients with cirrhosis who underwent vagus nerve-preserving RSD (n = 20) and LSD (n = 30) between September 2020 and October 2021. We compared patients' demographic, intraoperative, and perioperative variables. RSD and LSD were successful in all patients. Operative time did not differ significantly between the RSD group and LSD group (151.15 ± 21.78 min vs. 144.50 ± 24.30 min, P > 0.05), but intraoperative blood loss were significantly reduced in the RSD group (61.00 ± 34.93 mL vs. 105.00 ± 68.77 mL, P < 0.05). No statistically significant differences were found regarding intraoperative allogeneic transfusion rate, visual analog scale pain score on the postoperative first day, time to first oral intake, initial passage of flatus, initial off-bed activity, postoperative hospital stay, and overall perioperative complication rate (all P > 0.05). In conclusion, RSD is not only a technically feasible and safe procedure but it was associated with less blood loss than LSD for cirrhotic portal hypertension with gastroesophageal variceal bleeding and secondary hypersplenism. Registered at researchregistery.com: trial registration number is researchregistry7244, date of registration October 10, 2021, registered retrospectively.
机器人手术已在多种外科手术中被广泛接受。对于机器人辅助脾切除术联合奇静脉门静脉离断术（RSD）治疗肝硬化门静脉高压症所致食管胃静脉曲张出血和继发性脾功能亢进的临床效果，人们了解甚少。本研究的目的是评估RSD对于肝硬化门静脉高压症患者是否可行且安全，以及RSD是否优于腹腔镜脾切除术联合奇静脉门静脉离断术（LSD）。我们回顾性研究了2020年9月至2021年10月期间接受保留迷走神经的RSD（n = 20）和LSD（n = 30）的50例肝硬化患者的临床效果。我们比较了患者的人口统计学、术中及围手术期变量。所有患者的RSD和LSD均成功。RSD组和LSD组的手术时间无显著差异（151.15±21.78分钟对144.50±24.30分钟，P>0.05），但RSD组的术中出血量显著减少（61.00±34.93毫升对105.00±68.77毫升，P<0.05）。在术中异体输血率、术后第一天视觉模拟评分疼痛评分、首次经口进食时间、首次排气时间、首次离床活动时间、术后住院时间和围手术期总体并发症发生率方面，未发现统计学显著差异（均P>0.05）。总之，RSD不仅是一种技术上可行且安全的手术，而且对于伴有食管胃静脉曲张出血和继发性脾功能亢进的肝硬化门静脉高压症患者，其出血量比LSD少。在researchregistery.com注册：试验注册号为researchregistry7244，注册日期为2021年10月10日，回顾性注册。
