达芬奇机器人辅助腹腔镜胆总管囊肿根治术治疗儿童胆总管囊肿

目的总结达芬奇机器人辅助腹腔镜胆总管囊肿根治术治疗胆总管囊肿患儿的临床经验。方法回顾性分析中山大学附属第一医院小儿外科自2015年12月至2020年1月运用达芬奇机器人辅助腹腔镜胆总管囊肿根治术治疗的15例胆总管囊肿患儿。其中,男3例,女12例;患儿年龄为(62.40±34.64)个月,体重为(19.67±11.84)kg;Ⅰ型10例,Ⅳa型5例。患儿就诊的主要症状是腹痛和呕吐,术前行B型超声、CT或者磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)检查,发现胰胆管合流异常7例,诊断明确后采用达芬奇机器人辅助手术治疗。结果1例因肝右动脉解剖变异中转开放手术,其余14例均顺利完成达芬奇机器人辅助腹腔镜胆总管囊肿根治术,手术时间为(341.40±65.54)min,范围为240~460 min;机器人操作时间为(170.71±41.97)min,范围为95~243 min;胆肠吻合时间为(40.18±15.39)min,范围为25~67 min;胆肠吻合口直径为(14.57±9.94)mm,范围为4~35 mm。2例患儿术中输血;2例术中发现右副肝管,予行达芬奇机器人辅助下肝总管副肝管侧侧吻合术后再行肝管空肠吻合术。所有患儿随访至今,无近期或远期并发症出现。结论达芬奇机器人辅助腹腔镜胆总管囊肿根治术可顺利完成对直径较细肝总管和合并副肝管患儿的胆肠吻合,是一种安全有效的方法。

Robotic assisted surgery for choledochal cyst in children

Objective To describe our robotic-assisted surgery techniques and to assess the outcomes of robotic-assisted surgery for choledochal cysts in children.Methods A retrospective chart review was conducted for 15 children undergoing robotic-assisted surgery for choledochal cyst from December 2015 to January 2020.There were 3 boys and 12 girls with a mean age of(62.4±34.64)months and a mean body weight of(19.67±11.84)kg.The clinical types were TodaniⅠ(n=10)andⅣa(n=5).The major presenting symptoms were abdominal pain and vomiting.After ultrasonography,computed tomography(CT)or magnetic resonance cholangiopancreatography(MRCP)was performed.Seven definite cases of anomalous union of pancreaticobiliary duct underwent robotic-assisted surgery.Results Except for one conversion into open surgery,14 children underwent robotic-assisted surgery with a mean operative duration of(341.40±65.54)(240-460)min and a mean console time of(170.71±41.97)(95-243)min.And hepaticojejunostomy(HJA)was performed with a mean operative duration of(40.18±15.39)(25-67)min and a mean HJA diameter of(14.57±9.94)(4-35)mm.Two children required intraoperative blood transfusion.Two cases of right accessory hepatic duct underwent Roux-Y hepaticojejunostomy after fusing accessory hepatic duct and common duct.No short/long-term complications occurred.Conclusions Da Vinci robot-assisted laparoscopic radical resection of choledochal cyst can successfully complete choledochal anastomosis for children with smaller diameters of hepatic duct and accessory hepatic duct.It is both safe and efficacious.