[1]高跃,谭征,俞建根,等.达芬奇机器人手术系统治疗小儿食管裂孔疝疗效与安全性分析[J].临床小儿外科杂志,2023,22(07):666-670.[doi:10.3760/cma.j.cn101785-202106074-012]
　Gao Yue,Tan Zheng,Yu Jiangen,et al.Clinical analysis of da Vinci robotic surgical system repair of paraesophageal hiatus hernia in children[J].Journal of Clinical Pediatric Surgery,2023,22(07):666-670.[doi:10.3760/cma.j.cn101785-202106074-012]
点击复制

达芬奇机器人手术系统治疗小儿食管裂孔疝疗效与安全性分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第22卷 期数: 2023年07 页码: 666-670 栏目: 论著 出版日期: 2023-07-28
Title:
Clinical analysis of da Vinci robotic surgical system repair of paraesophageal hiatus hernia in children
作者:
高跃;  谭征;  俞建根;  梁靓;  黄婷;  章坚
浙江大学医学院附属儿童医院胸外科 国家儿童健康与疾病临床医学研究中心, 杭州 310052
Author(s):
Gao Yue;  Tan Zheng;  Yu Jiangen;  Liang Liang;  Huang Ting;  Zhang Jian
Department of Pediatric Thoracic Surgery, Children’s Hospital, Zhejang University School of Medicine, National Clinical Research Center for Children’s Health, Hangzhou 310052, China
关键词:
机器人手术; 疝; 食管裂孔; 外科手术; 儿童
Keywords:
Robotic Surgical Procedures; Hernia;  Hiatal; Surgical Procedures;  Operative; Child
DOI:
10.3760/cma.j.cn101785-202106074-012
摘要:
目的 初步探讨达芬奇机器人手术系统治疗小儿食管裂孔疝的临床疗效和安全性。方法 回顾性分析2020年6月至2020年12月浙江大学医学院附属儿童医院采用达芬奇机器人手术系统治疗的5例食管裂孔疝患儿资料。患儿术前均经上消化道造影明确诊断为食管裂孔疝，其中男3例，女2例；年龄6~28个月，平均15.4个月；Ⅰ型食管裂孔疝1例，Ⅲ型食管裂孔疝3例，Ⅳ型食管裂孔疝1例。收集5例患儿手术时间，出血量及治疗结局情况。结果 5例均通过达芬奇机器人手术系统顺利完成手术；手术时间105~165 min，平均手术时间132 min；术中平均出血量2.2 mL；术后平均住院时间7.4 d；经口进食时间为术后2~3 d；出院后1个月均于本院门诊行消化道造影复查，无一例疝孔复发。术后随访3~6个月，呕吐症状明显缓解，体重明显增加。结论 达芬奇机器人手术治疗小儿食管裂孔疝安全可靠、效果满意，尤其在精细解剖和精准缝合方面优势明显，为食管裂孔疝的治疗提供了新选择。
Abstract:
Objective To explore the efficacy and safety of da Vinci robotic surgical system (DVSS) for paraesophageal hiatus hernia in children.Methods From June 2020 to December 2020, 5 children of paraesophageal hiatus hernia was definitely diagnosed by upper gastrointestinal contrast radiography.They underwent DVSS.There were 3 boys and 2 girls with a mean age of (15.4±9.6) (5-28) months.Clinical types were Ⅰ (n=1), Ⅲ (n=3) and Ⅳ (n=1).Results Mean operative duration of Nissen fundoplication was 132(105-165) min, mean volume of intraoperative blood loss 2.2 ml, mean postoperative length of stay 7.4 days and mean postoperative feeding time (2-3) days.There was no conversion into open surg?ry.Re-examination of gastrointestinal contrast radiography at Month 1 post-discharge revealed no recurrence.Vomiting symptoms significantly relieved and weight gain was significant during a follow-up period of (3-6) months.Conclusion DVSS is both feasible and safe for repairing paraesophageal hiatus hernia in children.With obvious advantages of meticluous anatomy and precise suturing, it provides a new option.

参考文献/References:

[1] Yousef Y, Lemoine C, St-Vil D, et al.Congenital paraesophageal hernia:the Montreal experience[J].J Pediatr Surg, 2015, 50(9):1462-1466.DOI:10.1016/j.jpedsurg.2015.01.007.
[2] 吴雨昊, 冉云霓, 代江涛, 等.儿童先天性食管裂孔疝嵌顿并胃坏疽1例[J].中华胸心血管外科杂志, 2020, 36(1):46-47.DOI:10.3760/cma.j.issn.1001-4497.2020.01.012. Wu YH, Ran YN, Dai JT, et al.Congenital hiatal hernia associated with gastric gangrene in a child[J].Chin J Thorac Cardiovasc Surg, 2020, 36(1):46-47.DOI:10.3760/cma.j.issn.1001-4497.2020.01.012.
[3] Kohn GP, Price RR, DeMeester SR, et al.Guidelines for the management of hiatal hernia[J].Surg Endosc, 2013, 27(12):4409-4428.DOI:10.1007/s00464-013-3173-3.
[4] ?mamo?lu M, ?ay A, Ko?ucu P, et al.Congenital paraesophageal hiatal hernia:pitfalls in the diagnosis and treatment[J].J Pediatr Surg, 2005, 40(7):1128-1133.DOI:10.1016/j.jpedsurg.2005.03.060.
[5] 谭征, 李建华, 梁靓, 等.腹腔镜下Nissen和Toupet手术治疗小儿食管裂孔疝的近期疗效[J].中华小儿外科杂志, 2016, 37(10):742-745.DOI:10.3760/cma.j.issn.0253-3006.2016.10.005. Tan Z, Li JH, Liang L, et al.Near-term efficacy of laparoscopic repair of paraesophageal hiatus hernia via Nissen and Toupet in children[J].Chin J Pediatr Surg, 2016, 37(10):742-745.DOI:10.3760/cma.j.issn.0253-3006.2016.10.005.
[6] 程橙, 吴晔明.腹腔镜手术治疗小儿先天性食管裂孔疝的研究进展[J].临床小儿外科杂志, 2019, 18(12):1067-1071.DOI:10.3969/j.issn.1671-6353.2019.12.016. Cheng C, Wu YM.Advances of laparoscopic fundoplication for children with congenital esophageal hiatal hernia[J].J Clin Ped Sur, 2019, 18(12):1067-1071.DOI:10.3969/j.issn.1671-6353.2019.12.016.
[7] Lobe TE.The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children[J].Surg Endosc, 2007, 21(2):167-174.DOI:10.1007/s00464-006-0238-6.
[8] Ballantyne GH.The pitfalls of laparoscopic surgery:challenges for robotics and telerobotic surgery[J].Surg Laparosc Endosc Percutan Tech, 2002, 12(1):1-5.DOI:10.1097/00129689-200202000-00001.
[9] Khajuria A.Robotics and surgery:a sustainable relationship?[J].World J Clin Cases, 2015, 3(3):265-269.DOI:10.12998/wjcc.v3.i3.265.
[10] Lobe TE, Schropp KP, Lunsford K.Laparoscopic Nissen fundoplication in childhood[J].J Pediatr Surg, 1993, 28(3):358-361.DOI:10.1016/0022-3468(93)90231-9.
[11] Garvey EM, Ostlie DJ.Hiatal and paraesophageal hernia repair in pediatric patients[J].Semin Pediatr Surg, 2017, 26(2):61-66.DOI:10.1053/j.sempedsurg.2017.02.008.
[12] Fujiogi M, Michihata N, Matsui H, et al.Postoperative small bowel obstruction following laparoscopic or open fundoplication in children:a retrospective analysis using a nationwide database[J].World J Surg, 2018, 42(12):4112-4117.DOI:10.1007/s00268-018-4735-2.
[13] Ru W, Wu P, Feng SG, et al.Laparoscopic versus open Nissen fundoplication in children:a systematic review and meta-analysis[J].J Pediatr Surg, 2016, 51(10):1731-1736.DOI:10.1016/j.jpedsurg.2016.07.012.
[14] O’Connor SC, Mallard M, Desai SS, et al.Robotic versus laparoscopic approach to hiatal hernia repair:results after 7 years of robotic experience[J].Am Surg, 2020, 86(9):1083-1087.DOI:10.1177/0003134820943547.
[15] 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(8):701-707.DOI:10.12260/lcxewkzz.2021.08.001. Zhang SH, Gao ZG, Tou JF, et al.Current applications of robotic procedures in pediatric surgery[J].J Clin Ped Sur, 2021, 20(8):701-707.DOI:10.12260/lcxewkzz.2021.08.001.
[16] 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(8):708-711.DOI:10.3969/j.issn.1671-6353.2021.08.002. Tan Z, Yu JG, Liang L, et al.Robot-assisted thoracoscopy for congenital pulmonary diseases in children:a single-center study[J].J Clin Ped Sur, 2021, 20(8):708-711.DOI:10.3969/j.issn.1671-6353.2021.08.002.
[17] Cundy TP, Harling L, Marcus HJ, et al.Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children[J].J Pediatr Surg, 2014, 49(4):646-652.DOI:10.1016/j.jpedsurg.2013.12.014.
[18] Galvani CA, Loebl H, Osuchukwu O, et al.Robotic-assisted paraesophageal hernia repair:initial experience at a single institution[J].J Laparoendosc Adv Surg Tech A, 2016, 26(4):290-295.DOI:10.1089/lap.2016.0096.
[19] Gehrig T, Mehrabi A, Fischer L, et al.Robotic-assisted paraesophageal hernia repair-a case-control study[J].Langenbecks Arch Surg, 2013, 398(5):691-696.DOI:10.1007/s00423-012-0982-0.
[20] Wang ZH, Zheng Q, Jin ZM.Meta-analysis of robot-assisted versus conventional laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease[J].ANZ J Surg, 2012, 82(3):112-117.DOI:10.1111/j.1445-2197.2011.05964.x.
[21] Esposito C, Montupet P, van Der Zee D, et al.Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease[J].Surg Endosc, 2006, 20(6):855-858.DOI:10.1007/s00464-005-0501-2.
[22] 杜航向, 谭戈文, 杨治力, 等.腹腔镜Nissen与Toupet胃底折叠术式治疗胃食管反流病疗效比较的Meta分析[J].中华胃肠外科杂志, 2012, 15(8):814-818.DOI:10.3760/cma.j.issn.1671-0274.2012.08.019. Du HX, Tan GW, Yang ZL, et al.Efficacy of laparoscopic Nissen versus Toupet fundoplication for gastro-oesophageal reflux disease:Meta-analysis[J].Chin J Gastrointest Surg, 2012, 15(8):814-818.DOI:10.3760/cma.j.issn.1671-0274.2012.08.019.

相似文献/References:

[1]王勇,汤绍涛,毛永忠,等.腔镜下手术治疗小儿膈肌疾病31例[J].临床小儿外科杂志,2010,9(06):441.
[2]寿铁军李勇马能强龚晟.腹腔镜手术治疗小儿腹股沟斜疝1582例[J].临床小儿外科杂志,2011,10(01):0.
[3]朱琳琳吕志葆陈 功肖现民.腹腔镜下U型缝合膈肌缺损治疗儿童先天性胸骨后疝[J].临床小儿外科杂志,2010,9(03):0.
　ZHU Lin-lin,LV Zhi-bao,CHEN Gong,et al.Laparoscopic-assisted full-thickness anterior abdominal wall repair of Morgagni hernia in children.[J].Journal of Clinical Pediatric Surgery,2010,9(07):0.
[4].小儿先天性腰疝治疗分析[J].临床小儿外科杂志,2010,9(04):0.
　GUO Zheng-tuan,XU Quan,LI Peng,et al.Diagnosis and management of congenital lumbar hernias in children.[J].Journal of Clinical Pediatric Surgery,2010,9(07):0.
[5]唐志贤,余家康,王凤华,等.地塞米松对先天性膈疝胎鼠肺发育的影响[J].临床小儿外科杂志,2008,7(01):8.
[6]浦征宇,潘永康,段光琦,等.小儿腹股沟嵌顿性斜疝合并阑尾炎的临床分析[J].临床小儿外科杂志,2008,7(01):37.
[7]葛午平,俞钢,朱小春,等.新生儿小型脐膨出的产前诊断与手法复位治疗[J].临床小儿外科杂志,2008,7(04):0.
[8]杜宝峰,易军,刘继炎,等.腹腔镜治疗复发性斜疝58例[J].临床小儿外科杂志,2008,7(04):0.
[9]王剑锋,刘国庆,唐华建,等.腹腔镜下网片修补小儿巨大腹股沟斜疝的初步报告[J].临床小儿外科杂志,2007,6(01):31.
[10]唐剑平,何东北,唐向东,等.腹腔镜下小儿腹股沟斜疝高位结扎术45例[J].临床小儿外科杂志,2007,6(01):24.

备注/Memo

收稿日期:2021-06-30。
基金项目:2017年浙江省医药卫生科技计划项目（2017KY435）
通讯作者:谭征,Email:tanzheng@zju.edu.cn

更新日期/Last Update: 1900-01-01