达芬奇机器人在小儿外科手术中的应用（附20例报告）

目的 达芬奇机器人手术系统具有独特的优势,是当前微创外科手术的前沿领域。本文通过回顾分析和总结我中心在机器人辅助下完成小儿外科手术资料,为今后深入开展机器人小儿外科手术提供经验和参考。方法 2007～2012年,我中心累积采用机器人辅助完成小儿外科手术20例（男女各10例;平均年龄10.7岁）。手术包括9例胃底折叠术、5例肾盂成形术、2例胆总管囊肿切除术、2例食管部分切除术、1例输尿管膀胱再植术和1例可控性尿流改道术。结果 9例胃底折叠平均手术时间为220.1 min,5例肾盂成形平均手术时间为204.2 min。1例胆总管囊肿术中因组织分离困难而中转开腹。1例先天性食管狭窄伴食管气管瘘行食管部分切除术后2周复发,经二次手术治愈。结论机器人手术是小儿微创外科治疗的有效手段。仍需对患儿长期随访,以进一步评估机器人手术的远期效果。

Da Vinci Robotic System for Pediatric Surgery: Report of First 20 Cases

Objective The Da Vinci robotic surgery system offers particular advantages and is currently a frontier study in the field of minimally invasive surgery. In this study, we retrospectively reviewed our experience in robotic surgical system in pediatric surgery as a tertiary referral center. We hope this pilot study can offer some recommendation for future development. Methods Since 2007 to 2012, a total of 20 robotic-assisted operations （F： 10; M： 10） have been performed. The average age of the patient was 10.7 y （ ranged from 3 to 18 y）. The operations included 9 cases of fundopiication （ one of them also underwent robotic assisted Heller＇ s operation for achalasia at the same time） , 5 cases of pyelopiasty, 2 cases of excision of choledochal cyst, 2 cases of partial esophagectomy, 1 case of ureteric reimplantation, and 1 case of Mitrofanoff procedure. Results The mean operation time of fundoplication and pyeloplasty were respectively 220.1 and 204.2 minutes. One patient who underwent choledochal cyst excision was converted to open surgery due to difficult dissection. Disease recurrence was noted in one patient with partial esophagectomy for congenital esophageal stenosis due to tracheo-esophageal remnant. Conclusion The Da Vinci robotic surgical system is a reliable and effective approach for pediatric surgery. Long-term follow-up study is needed for further evaluation of its efficacy.