Tao Boyuan,Zhong Zhizu,Zeng Jixiao,et al.Efficacy and safety of robotic assisted surgery versus conventional laparoscopy for pediatric choledochal cyst[J].Journal of Clinical Pediatric Surgery,2026,(03):214-219.[doi:10.3760/cma.j.cn101785-20251226-00131]
达芬奇机器人辅助手术与传统腹腔镜手术治疗儿童胆总管囊肿的疗效及安全性对比研究
- Title:
- Efficacy and safety of robotic assisted surgery versus conventional laparoscopy for pediatric choledochal cyst
- Keywords:
- Choledochal Cyst; Laparoscopy; Surgical Procedures; Operative; Robotic Surgical Procedures; Child
- 摘要:
- 目的 对比达芬奇机器人辅助手术(robotic-assisted hepaticojejunostomy,RAH)与传统四孔法腹腔镜手术(conventional four-port laparoscopic hepaticojejunostomy,CLH)治疗儿童胆总管囊肿(choledochal cyst,CDC)的临床疗效及安全性。方法 本研究为回顾性队例研究,收集2020年1月至2025年6月广州医科大学附属妇女儿童医疗中心胃肠外科收治的132例CDC患儿临床资料,按手术方式分为机器人组(49例,行RAH)和传统组(83例,行CLH)。比较两组患儿基线数据、术中指标、术后恢复情况及近中期并发症发生率。结果 两组患儿年龄、体重、囊肿分型等基线资料差异无统计学意义(P＞0.05)。与传统组相比,机器人组总手术时间[(197.8±43.0)min 比(178.9±41.0)min]、囊肿分离及胆道重建时间[(137.2±28.7)min 比(126.8±26.7)min]、引流管留置时间[80.0(72.5,90.9)h 比66.1(58.3,88.9)h]、肠功能恢复时间[(16.5±5.3)h 比(14.2±5.6)h]均显著缩短,术中出血量[(6.0±1.4)mL 比(5.2±1.8)mL]显著减少,镇痛泵撤除后6 h疼痛评分[(2.6±0.7)分比(2.9±0.5)分]显著升高,切口满意度评分[(8.8±0.6)分比(8.4±0.8)分]显著降低,住院费用[(44 830.0±7 595.0)元比(76 653.1±5 743.3)元]显著增加,上述指标差异均有统计学意义(P<0.05)。两组胆肠吻合口直径、引流管留置率、术后住院时间、随访时间及近中期并发症发生率差异无统计学意义(P＞0.05)。结论 达芬奇机器人辅助手术凭借操作灵活性及精准性,可降低儿童CDC手术关键步骤难度,术后恢复更快,近中期并发症发生率与传统腹腔镜手术相当,但存在腹壁Trocar切口较大、术后瘢痕相对明显及费用较高的不足。
- Abstract:
- Objective To compare clinical efficacy between da Vinci robot assisted hepaticojejunostomy (RAH) versus conventional four-port laparoscopic hepaticojejunostomy (CLH) for pediatric choledochal cyst.Methods From January 2020 to June 2025,133 children with choledochal cyst were hospitalized.According to the inclusion criteria,the relevant clinical data were retrospectively examined.RAH (n=49) and CLH (n=83) were performed.Baseline profiles,intraoperative findings and curative effect were compared between two groups.Results No statistically significant inter-group differences existed in age,weight and cyst type (P>0.05).As compared to traditional group,da Vinci robotic group showed significantly shorter total operative duration (T1)[(197.8±43.0) vs. (178.9±41.0) min,P=0.014],cyst dissection and biliary reconstruction time (T2)[(137.2±28.7) vs. (126.8±26.7) min,P=0.040],duration of drainage tube retention[80.0(72.5,90.9) vs. 66.1(58.3,88.9) h,P=0.035]and intestinal function recovery time[(16.5±5.3) vs.(14.2±5.6) h,P=0.023].Intraoperative blood loss was significantly lesser in da Vinci robotic group than that in traditional group with a significant difference[(6.0±1.4) vs. (5.2±1.8) mL,P=0.012].While pain scores at6hours after analgesic pump removal[(2.6±0.7) vs. (2.9±0.5) points,P=0.016]and hospitalization expenses[(44 830.0±7595.0) vs. (76 653.1±5 743.3) yuan,P<0.001]were significantly higher.Incision satisfaction score was significantly lower in da Vinci robotic group than that in traditional group[(8.8±0.6) vs. (8.4±0.8) points,P=0.024].There were significant inter-group differences.No statistically significant intergroup differences existed in biliary-enteric anastomosis diameter,drainage tube retention rate,postoperative hospitalization stay,follow-up length or short- to medium-term complication rates (P>0.05).Conclusions With its flexible operability and precision,robot assisted surgery significantly may reduce surgical difficulty during cyst separation and hepaticojejunostomy.As compared with CLH,RAH facilitates faster postoperative recovery and it has demonstrated comparable short-and medium-term complication rates.However,its limitations include larger Trocar incisions,more noticeable postoperative scarring and higher expenses.
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备注/Memo
收稿日期:2025-12-26。
基金项目:广州地区临床特色技术项目(2026P-TS015);广州市卫生健康科技一般引导项目(20261A011022)
通讯作者:曾纪晓,Email:zengjixiao@163.com