Xu Xiaogang,Zeng Jixiao,Luo Yuanyuan,et al.Robotic hepatectomy in a 14-month-old child of hepatoblastoma without the first hepatic portal control:a first case report in the world[J].Journal of Clinical Pediatric Surgery,2023,22(12):1114-1118.[doi:10.3760/cma.j.cn101785-202307016-004]
全球首例不阻断第一肝门的机器人肝切除术治疗儿童肝母细胞瘤
- Title:
- Robotic hepatectomy in a 14-month-old child of hepatoblastoma without the first hepatic portal control:a first case report in the world
- 摘要:
- 目的 总结全球首例不阻断第一肝门的机器人肝切除术治疗儿童肝母细胞瘤(hepatoblastoma,HB)的手术经验。方法 回顾性分析2023年6月广州市妇女儿童医疗中心经机器人手术治疗的1例14月龄HB患儿诊疗经过。该患儿肿瘤位于肝右叶S5、S6,大小约9.0 cm×6.9 cm×6 cm,行达芬奇机器人肝切除术,总结术中Trocar布局、手术技巧、围术期处理情况以及治疗结局等。结果 术中采用4条机械臂加1个辅助孔,未阻断第一肝门,使用超声刀及Hemo-lock凝断并结扎肝脏血管,完整切除肿瘤(S5、S6、部分S7及胆囊)。手术时间120 min,出血量50 mL。术后无胆漏、出血、感染等并发症,病理检查结果提示胎儿上皮型HB,术后第7天达出院指征,术后第14天予C5V(顺铂＋5-氟尿嘧啶＋长春新碱)方案化疗。术后30 d、53 d及90 d血甲胎蛋白(alpha fetoprotein,AFP)分别为36.88 ng/mL、8.90 ng/mL、6.61ng/mL,超声检查未见新发病灶。经查新,此例为全球首例不阻断第一肝门的机器人肝切除术治疗儿童HB。结论 运用达芬奇机器人可以在不阻断第一肝门的情况下实施非解剖性肝切除术治疗儿童HB,手术安全、可行,但目前相关报道较少,需继续积累病例及经验。
- Abstract:
- Objective To summarize the surgical experiences of the first-ever global case of robotic hepatectomy (RH) in a child with hepatoblastoma (HB) without the first hepatic portal control.Methods A 14-month-old HB boy reviewed retrospectively.Located in right hepatic lobe S5/S6,tumor had a dimension of 9.0×6.9×6 cm.RH was performed with Da Vinci system.Trocar positioning,operative skills and perioperative managements of pediatric robotic hepatectomy were recorded.Results Without the first hepatic control (Pringle),hepatic vessels were ligated by an ultrasonic knife with a Hemo-lock.Tumors (S5,S6,partial S7 & gallbladder) were completely removed with four robotic arms and one auxiliary hole.Operative duration was 120 min and volume of blood loss 50 ml.There were no such postoperative complications as bile leakage,hemorrhage or infection.Postoperative pathology hinted at HB.Discharge index was attained at Day 7 post-RH.C5V chemotherapeutic regimen (cisplatin + 5-fluorouracil + vincristine) was offered at Day 14.AFP was 36.88,8.90 and 6.61 ng/ml at Month 1,Day 53 and Month 3 post-RH.No new lesions were detected by ultrasonography.Conclusions RH is both safe and feasible for infantile HB without the first hepatic control (Pringle).Currently there are few related reports of RH in children.It is imperative to continue expanding cases and accumulating experiences.
参考文献/References:
[1] Darbari A,Sabin KM,Shapiro CN,et al.Epidemiology of primary hepatic malignancies in U.S.children[J].Hepatology,2003,38(3):560-566.DOI:10.1053/jhep.2003.50375.
[2] Haeberle B,Rangaswami A,Krailo M,et al.The importance of age as prognostic factor for the outcome of patients with hepatoblastoma:analysis from the Children’s Hepatic tumors International Collaboration (CHIC) database[J].Pediatr Blood Cancer,2020,67(8):e28350.DOI:10.1002/pbc.28350.
[3] 中国抗癌协会小儿肿瘤专业委员会,中华医学会小儿外科分会肿瘤专业组.儿童肝母细胞瘤多学科诊疗专家共识(CCCG-HB-2016)[J].中华小儿外科杂志,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003. Specialty Committee of Pediatric Oncology,Chinese Anti-Cancer Association; Specialty Committee of Oncology,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Multidisciplinary Management of Hepatoblastoma (CCCG-HB-2016)[J].Chin J Pediatr Surg,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003.
[4] 郑百俊,程继文,高亚,等.腹腔镜肝切除术与开腹肝切除术治疗肝母细胞瘤的临床效果比较[J].临床小儿外科杂志,2019,18(11):935-940.DOI:10.3969/j.issn.1671-6353.2019.11.008. Zheng BJ,Cheng JW,Gao Y,et al.Safety,feasibility and short-term outcome of laparoscopic liver resection versus open liver resection for hepatoblastoma[J].J Clin Ped Sur,2019,18(11):935-940.DOI:10.3969/j.issn.1671-6353.2019.11.008.
[5] 靳曙光,徐志诚,汪俊祥,等.腹腔镜下儿童肝脏肿瘤切除术八例报告[J].中华小儿外科杂志,2019,40(8):673-677.DOI:10.3760/cma.j.issn.0253-3006.2019.08.001. Jin SG,Xu ZC,Wang JX,et al.Laparoscopic resection of hepatic tumors in children:a report of 8 cases[J].Chin J Pediatr Surg,2019,40(8):673-677.DOI:10.3760/cma.j.issn.0253-3006.2019.08.001.
[6] Chen DX,Wang SJ,Jiang YN,et al.Robot-assisted gallbladder-preserving hepatectomy for treating S5 hepatoblastoma in a child:a case report and review of the literature[J].World J Clin Cases,2019,7(7):872-880.DOI:10.12998/wjcc.v7.i7.872.
[7] Giulianotti PC,Coratti A,Angelini M,et al.Robotics in general surgery:personal experience in a large community hospital[J].Arch Surg,2003,138(7):777-784.DOI:10.1001/archsurg.138.7.777.
[8] Liu R,Wakabayashi G,Kim HJ,et al.International consensus statement on robotic hepatectomy surgery in 2018[J].World J Gastroenterol,2019,25(12):1432-1444.DOI:10.3748/wjg.v25.i12.1432.
[9] Zhu P,Liao W,Ding ZY,et al.Learning curve in robot-assisted laparoscopic liver resection[J].J Gastrointest Surg,2019,23(9):1778-1787.DOI:10.1007/s11605-018-3689-x.
[10] Liu Q,Zhang WG,Zhao JJ,et al.Propensity-score matched and coarsened-exact matched analysis comparing robotic and laparoscopic major hepatectomies:an international multicenter study of 4822 cases[J].Ann Surg,2023,278(6):969-975.DOI:10.1097/SLA.0000000000005855.
[11] 《机器人肝胆胰手术操作指南》制定委员会.机器人肝胆胰手术操作指南[J].临床肝胆病杂志,2019,35(7):1459-1471.DOI:10.3969/j.issn.1001-5256.2019.07.009. Drafting Committee of Clinical Practice Guidelines for Robotic Hepatopancreatobiliary Surgery:Clinical Practice Guidelines for Robotic Hepatopancreatobiliary Surgery[J].J Clin Hepatol,2019,35(7):1459-1471.DOI:10.3969/j.issn.1001-5256.2019.07.009.
[12] Montalti R,Giglio MC,Wu AGR,et al.Risk factors and outcomes of open conversion during minimally invasive major hepatectomies:an international multicenter study on 3880 procedures comparing the laparoscopic and robotic approaches[J].Ann Surg Oncol,2023,30(8):4783-4796.DOI:10.1245/s10434-023-13525-0.
[13] Cauchy F,Fuks D,Nomi T,et al.Incidence,risk factors and consequences of bile leakage following laparoscopic major hepatectomy[J].Surg Endosc,2016,30(9):3709-3719.DOI:10.1007/s00464-015-4666-z.
[14] 郑百俊,余辉,李鹏,等.小儿腹腔镜肝切除的技术改进及疗效分析[J].临床小儿外科杂志,2022,21(7):622-626.DOI:10.3760/cma.j.cn101785-202205026-005. Zheng BJ,Yu H,Li P,et al.Technical improvements and therapeutic efficacies of laparoscopic liver resection in children[J].J Clin Ped Sur,2022,21(7):622-626.DOI:10.3760/cma.j.cn101785-202205026-005.
[15] 徐晓钢,曾纪晓,刘斐,等.经脐单孔3D腹腔镜手术治疗小儿先天性胆总管囊肿[J].中华腔镜外科杂志(电子版),2021,14(3):172-176.DOI:10.3877/cma.j.issn.1674-6899.2021.03.009. Xu XG,Zeng JX,Liu F,et al.Natural orifice transumbilical single-port three-dimensional laparoscopic hepojejunostomy for congenital choledochal cyst in children[J].Chin J Laparosc Surg (Electronic Ed),2021,14(3):172-176.DOI:10.3877/cma.j.issn.1674-6899.2021.03.009.
[16] 兰梦龙,曾纪晓,刘斐,等.常规器械行单孔腹腔镜手术在儿童普通外科疾病中的临床应用初探[J].中华腔镜外科杂志(电子版),2021,14(6):353-358.DOI:10.3877/cma.j.issn.1674-6899.2021.06.007. Lan ML,Zeng JX,Liu F,et al.Preliminary application of conventional instruments during single-port laparoscopy in children at departments of general surgery[J].Chin J Laparosc Surg (Electron Ed),2021,14(6):353-358.DOI:10.3877/cma.j.issn.1674-6899.2021.06.007.
相似文献/References:
[1]陈立才,李朋飞,黄一敏,等. 抗EpCAM单克隆抗体治疗肝母细胞瘤的动物实验研究[J].临床小儿外科杂志,2019,18(01):63.
Chen Licai,Li Pengfei,Huang Yimin,et al. Targeting therapy of antiEpCAM monoclonal antibody in hepatoblastoma animal model.[J].Journal of Clinical Pediatric Surgery,2019,18(12):63.
[2]成英杰,单慈,石寒菡,等.MicroRNAs在肝母细胞瘤诊断、鉴别诊断及预后评估中的研究进展[J].临床小儿外科杂志,2019,18(08):660.[doi:10.3969/j.issn.1671-6353.2019.08.009]
Cheng Yingjie,Shan Ci,Shi Hanhan,et al.Research advances of MicroRNAs in the diagnosis,differential diagnosis and prognostic evaluation of hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2019,18(12):660.[doi:10.3969/j.issn.1671-6353.2019.08.009]
[3]张书豪,高志刚,钭金法,等.机器人手术在小儿外科领域的应用现状[J].临床小儿外科杂志,2021,20(08):701.[doi:10.12260/lcxewkzz.2021.08.001]
Zhang Shuhao,Gao Zhigang,Tou Jinfa,et al.Current applications of robotic procedures in pediatric surgery[J].Journal of Clinical Pediatric Surgery,2021,20(12):701.[doi:10.12260/lcxewkzz.2021.08.001]
[4]谭征,俞建根,梁靓,等.机器人辅助胸腔镜技术治疗小儿先天性肺部疾病的单中心研究[J].临床小儿外科杂志,2021,20(08):708.[doi:10.12260/lcxewkzz.2021.08.002]
Tan Zheng,Yu Jiangeng,Liang Liang,et al.Robot-assisted thoracoscopy in the treatment of congenital pulmonary diseases in children[J].Journal of Clinical Pediatric Surgery,2021,20(12):708.[doi:10.12260/lcxewkzz.2021.08.002]
[5]赵扬,周辉霞,马立飞,等.机器人辅助腹腔镜技术应用于儿童肾上腺肿物切除术的初步经验[J].临床小儿外科杂志,2021,20(08):712.[doi:10.12260/lcxewkzz.2021.08.003]
Zhao Yang,Zhou Huixia,Ma Lifei,et al.Preliminary experience of robot-assisted laparoscopic adrenal mass resection in children[J].Journal of Clinical Pediatric Surgery,2021,20(12):712.[doi:10.12260/lcxewkzz.2021.08.003]
[6]章跃滨,陈青江,蔡多特,等.机器人手术系统辅助儿童脾切除术三例并文献复习[J].临床小儿外科杂志,2021,20(08):718.[doi:10.12260/lcxewkzz.2021.08.004]
Zhang Yuebin,Chen Qingjiang,Cai Duote,et al.Robot-assisted laparoscopic splenectomy in children: a report of 3 cases with review of the literature[J].Journal of Clinical Pediatric Surgery,2021,20(12):718.[doi:10.12260/lcxewkzz.2021.08.004]
[7]马洪,汤显能,郭跃明.机器人手术系统辅助经皮原位固定术治疗儿童股骨头骨骺滑脱的比较研究[J].临床小儿外科杂志,2021,20(08):724.[doi:10.12260/lcxewkzz.2021.08.005]
Ma Hong,Tang Xianneng,Guo Yueming.Comparative study of percutaneous in stu fixation of slipped capital femoral epiphysis assisted by surgical robotic system[J].Journal of Clinical Pediatric Surgery,2021,20(12):724.[doi:10.12260/lcxewkzz.2021.08.005]
[8]陈艳,周立军,汪亚平,等.机器人辅助腹腔镜技术治疗儿童肾上腺嗜铬细胞瘤一例并文献复习[J].临床小儿外科杂志,2021,20(08):731.[doi:10.12260/lcxewkzz.2021.08.006]
Chen Yan,Zhou Lijun,Wang Yaping,et al.Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2021,20(12):731.[doi:10.12260/lcxewkzz.2021.08.006]
[9]胡家祥,聂梅兰,杨嘉飞,等.儿童上尿路结石的外科治疗进展[J].临床小儿外科杂志,2021,20(10):985.[doi:10.12260/lcxewkzz.2021.10.017]
Hu Jiaxiang,Nie Meilan,Yang Jiafei,et al.Recent advances in surgical treatment of upper urinary calculi in children[J].Journal of Clinical Pediatric Surgery,2021,20(12):985.[doi:10.12260/lcxewkzz.2021.10.017]
[10]朱炜玮,周辉霞,李品,等.机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗原发性膀胱输尿管反流的疗效对比[J].临床小儿外科杂志,2022,21(05):437.[doi:10.3760/cma.j.cn101785-202109034-008]
Zhu Weiwei,Zhou huixia,Li Pin,et al.Comparison of clinical efficacy of robot-assisted laparoscopic Lich-Gregoir procedure and gas-bladder laparoscopic Cohen ureteral reimplantation for primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2022,21(12):437.[doi:10.3760/cma.j.cn101785-202109034-008]
备注/Memo
收稿日期:2023-7-8。
基金项目:国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州地区临床特色技术项目(2023C—TS48);广州市卫生健康科技项目(20231A011040)
通讯作者:曾纪晓,Email:zengjixiao@163.com