Chen Sai,Gao Zhigang,Chen Qingjiang,et al.Comparison of short-term outcomes between robot-assisted and laparoscopic-assisted hepaticojejunostomy in children[J].Journal of Clinical Pediatric Surgery,2025,(11):1017-1021.[doi:10.3760/cma.j.cn101785-202507023-004]
机器人辅助与腹腔镜辅助的儿童肝空肠吻合术短期疗效对比
- Title:
- Comparison of short-term outcomes between robot-assisted and laparoscopic-assisted hepaticojejunostomy in children
- 摘要:
- 目的 采用倾向性评分匹配法(propensity score matching,PSM),比较机器人辅助肝管空肠吻合术(robot-assisted hepaticojejunostomy,RAHJ)与腹腔镜辅助肝管空肠吻合术(laparoscopic hepaticojejunostomy,LAHJ)治疗先天性胆总管囊肿患儿的短期疗效及安全性。方法 回顾性分析2018年9月至2024年2月,在浙江大学医学院附属儿童医院肝胆外科诊治中心接受胆总管囊肿根治术治疗的356例先天性胆总管囊肿患儿临床资料,按照手术方式的不同分为RAHJ组(n=195)和LAHJ组(n=161)。收集分析两组人口学资料和手术结果,为有效控制混杂因素,将两组患儿的数据采用PSM进行匹配。结果 经1[KG0.5mm]∶1匹配后,纳入比较的RAHJ组与LAHJ组患儿数量均为129例。结果显示,RAHJ组在术中出血量[5(5,5)mL比10(5,10)mL]及术后住院时间[(9(8,12)d比11(10,14)d]方面均优于LAHJ组,差异有统计学意义(P<0.05);RAHJ组住院费用明显高于LAHJ组[78 010.72(74 125.87,86 976.82)元比31 769.05(27 868.79,37 954.09)元],差异有统计学意义(P<0.05)。两组手术时间、术后禁食时间情况差异无统计学意义(P>0.05)。结论 机器人辅助手术系统治疗儿童先天性胆总管囊肿是一种安全可行的术式。相较于腹腔镜辅助手术,RAHJ在降低术中出血量和缩短术后住院时间方面具有显著优势,提示其在改善患儿术后恢复方面表现更佳。尽管RAHJ在器械成本方面有所增加,但其在临床疗效上的获益值得关注。
- Abstract:
- Objective To compare the short-term efficacy and safety of robot-assisted hepaticojejunostomy (RAHJ) and laparoscopic-assisted hepaticojejunostomy (LAHJ) in the treatment of children with congenital choledochal cysts using propensity score matching (PSM). Methods Clinical data of 356 pediatric patients with congenital choledochal cysts who underwent radical cyst excision at the Hepatobiliary Surgery Center of the Children’s Hospital Affiliated to Zhejiang University School of Medicine,between September 2018 and February 2024 were retrospectively analyzed.According to the surgical approach,patients were divided into the RAHJ group (n=195) and LAHJ group (n=161).Demographic data and perioperative outcomes were collected and analyzed.To minimize confounding factors,a1[KG0.5mm]∶1 PSM analysis was performed. Results After matching,129 patients were included in each group.The RAHJ group showed significantly less intraoperative blood loss[5(5,5)mL vs.10(5,10)mL]and shorter postoperative hospital stay[9(8,12) days vs.11(10,14)days]than the LAHJ group (P<0.05).However,hospitalization costs were significantly higher in the RAHJ group[78,010.72(74,125.87-86,976.82) yuan vs.31,769.05(27,868.79-37,954.09),P<0.05].No significant differences were found between the two groups in operative time or postoperative fasting duration(P>0.05). Conclusions The robot-assisted surgical system is safe and feasible option for treating congenital choledochal cysts in children.Compared with laparoscopy-assisted surgery,RAHJ offers significant advantages in reducing intraoperative bleeding and shortening postoperative hospital stay,indicating superior recovery outcomes.Although RAHJ incurs higher procedural costs,its clinical benefits merit further attention.
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备注/Memo
收稿日期:2025-7-10。
基金项目:国家重点研发项目(2024YFC2707005)
通讯作者:高志刚,Email:ebwk@zju.edu.cn