Ren Yuqi,Yan Xueqiang.Comparison of early efficacies ects in between Da Vinci’s robot surgery and versus open kasai surgery in the treatment of for biliary atresia[J].Journal of Clinical Pediatric Surgery,2023,22(12):1151-1155.[doi:10.3760/cma.j.cn101785-202212015-011]
达芬奇机器人手术与传统开腹手术治疗胆道闭锁的早期疗效对比
- Title:
- Comparison of early efficacies ects in between Da Vinci’s robot surgery and versus open kasai surgery in the treatment of for biliary atresia
- Keywords:
- Biliary Atresia; Surgical Procedures; Operative; Robotic Surgical Procedures; Open Abdomen Techniques; Treatment Outcome; Comparative Study
- 摘要:
- 目的 比较达芬奇机器人辅助Kasai手术与传统开腹Kasai手术治疗胆道闭锁的早期疗效与安全性。方法 回顾性分析2021年1月至2022年6月武汉市儿童医院收治的30例胆道闭锁患儿临床资料,患儿均行Kasai手术,根据手术方式分为达芬奇机器人Kasai手术(robotic portoenterostomy,RP)组和传统开腹Kasai手术(open portoenterostomy,OP)组。收集分析两组患儿一般资料、手术前后生化指标(总胆红素、直接胆红素、谷丙转氨酶和谷草转氨酶)、并发症、住院时间、术后6个月内胆管炎及黄疸清除情况,比较两组患儿短期随访结果。结果 RP组9例,其中男8例,女1例;体重5.4(5.0,6.5)kg;日龄65(56,90)d;。OP组21例,其中男13例;女8例;体重4.9(4.5,5.8)kg;日龄59(49,85)d;。两组上述指标差异均无统计学意义(P＞0.05)。RP组和OP组术前总胆红素[179.6(116.2,224.5)mmol/L比170.3(129.6,208.2)mmol/L]、术后1周总胆红素[115.0(69.3,143.4)mmol/L比120.3(88.5,160.7)mmol/L]、术前直接胆红素 [83.4(79.0,155.7)mmol/L比97.6(82.5,147.4)mmol/L]、术后1周直接胆红素[71.6(47.6,100.2)mmol/L比82.1(64.3,117.5)mmol/L]、术前谷丙转氨酶[175(114,234)U/L比147(94,218)U/L]、术后1周谷丙转氨酶[144(119,310)U/L比183(150,253)U/L ]、术前谷草转氨酶[212(164,269)U/L比129(96,157)U/L]、术后1周谷草转氨酶[167(90,191)U/L比120(80,155)U/L]比较,差异均无统计学意义(P＞0.05)。各组患儿手术后生化指标对比手术前,除OP组谷丙转氨酶术后升高外,其余均降低,差异均有统计学意义(P＜0.05)。RP组和OP组术后住院天数[15(12.5,21.5)d比15(12,17.5)d]、并发症发生率(2/9比3/21)、胆管炎发生率(7/9比15/21)及黄疸清除率(3/9比12/21)比较,差异均无统计学意义(P＞0.05)。结论 达芬奇机器人Kasai手术与传统开腹Kasai手术治疗胆道闭锁的早期疗效相当。
- Abstract:
- Objective To compare the early efficacy and safety of Da Vinci robot-assisted Kasai versus traditional open surgery for biliary atresia (BA).Methods From January 2021 to June 2022,retrospective analysis was performed for 9 children undergoing robotic portoenterostomy (RP) and another 21 children open portoenterostomy (OP) within the same period.General profiles,perioperative biochemical parameters,postoperative complications and hospitalization stay were compared. Results In RP group,there were 8 boys and 1 girl with a body weight of 5.4(5.0-6.5) kg and an average age of 65(56-90) day; In OP group,13 boys and 8 girls with a body weight of 4.9 (4.5-5.8) kg and an average age of 59(49,85) day.No significant differences existed among the above parameters (P>0.05).In RP and OP groups,preoperative total bilirubin [179.6(116.2-224.5) mmol/L vs.170.3(129.6-208.2) mmol/L],postoperative total bilirubin [115.0(69.3-143.4) mmol/L vs.120.3(88.5-160.7) mmol/L],preoperative direct bilirubin[83.4(79.0-155.7) mmol/L vs.97.6(82.5-147.4) mmol/L],postoperative direct bilirubin [71.6(47.6-100.2) mmol/L vs.82.1(64.3-117.5) mmol/L],preoperative alanine aminotransferase [175(114-234) U/L vs.147(94-218) U/L],postoperative alanine aminotransferase [144(119-310) U/L vs.183(150-253) U/L],preoperative aspartate aminotransferase [212(164-164) U/L vs.129 (96-157) U/L] and postoperative aspartate aminotransferase [167(90-191) U/L vs.120 (80-155) U/L].There were no differences of statistical significance (P>0.05).Compared with those before operation,the biochemical indexes of children in all groups after operation were decreased except for the increase of alanine aminotransferase after operation in OP group,with statistical significance (P<0.05).Postoperative hospitalization stay [15(12.5-21.5) day vs.15(12-17.5) day],postoperative complication rate (2/9 vs.3/21),cholangitis rate (7/9 vs.15/21) and jaundice clearance (3/9 vs.12/21) showed no inter-group differences of statistical significance (P>0.05).Conclusions Early curative efficacy of Da Vinci robotic surgery and open surgery is comparable for BA.
参考文献/References:
[1] Hartley JL,Davenport M,Kelly DA.Biliary atresia[J].Lancet,2009,374(9702):1704-1713.DOI:10.1016/S0140-6736(09)60946-6.
[2] Dutta S,Woo R,Albanese CT.Minimal access portoenterostomy:advantages and disadvantages of standard laparoscopic and robotic techniques[J].J Laparoendosc Adv Surg Tech A,2007,17(2):258-264.DOI:10.1089/lap.2006.0112.
[3] Meehan JJ,Elliott S,Sandler A.The robotic approach to complex hepatobiliary anomalies in children:preliminary report[J].J Pediatr Surg,2007,42(12):2110-2114.DOI:10.1016/j.jpedsurg.2007.08.040.
[4] Liu J,Dong R,Chen G,et al.Risk factors and prognostic effects of cholangitis after Kasai procedure in biliary atresia patients:a retrospective clinical study[J].J Pediatr Surg,2019,54(12):2559-2564.DOI:10.1016/j.jpedsurg.2019.08.026.
[5] 中华医学会小儿外科学分会肝胆外科学组,中国医师协会器官移植医师分会儿童器官移植学组.胆道闭锁诊断及治疗指南(2018版)[J].临床肝胆病杂志,2019,35(11):2435-2440.DOI:10.3969/j.issn.1001-5256.2019.11.009. Section of Hepatobiliary Surgery,Branch of Pediatric Surgery,Chinese Medical Association,Section of Pediatric Hepatic Transplantation,Branch of Organ Transplantation,Chinese Medical Doctor Association.Guidelines for diagnosingDiagnosing & treating Treating biliary Biliary atresiaAtresia (2018 editionEdition)[J].J Clin Hepatol,2019,35(11):2435-2440.DOI:10.3969/j.issn.1001-5256.2019.11.009.
[6] Lee S,Park H,Moon SB,et al.Long-term results of biliary atresia in the era of liver transplantation[J].Pediatr Surg Int,2013,29(12):1297-1301.DOI:10.1007/s00383-013-3366-9.
[7] Esteves E,Clemente Neto E,Ottaiano Neto M,et al.Laparoscopic Kasai portoenterostomy for biliary atresia[J].Pediatr Surg Int,2002,18(8):737-740.DOI:10.1007/s00383-002-0791-6.
[8] Ure BM,Kuebler JF,Schukfeh N,et al.Survival with the native liver after laparoscopic versus conventional kasai portoenterostomy in infants with biliary atresia:a prospective trial[J].Ann Surg,2011,253(4):826-830.DOI:10.1097/SLA.0b013e318211d7d8.
[9] Li ZH,Ye YQ,Wu ZG,et al.Learning curve analysis of laparoscopic Kasai portoenterostomy[J].J Laparoendosc Adv Surg Tech A,2017,27(9):979-982.DOI:10.1089/lap.2016.0204.
[10] Wang B,Feng Q,Ye XS,et al.The experience and technique in laparoscopic portoenterostomy for biliary atresia[J].J Laparoendosc Adv Surg Tech A,2014,24(5):350-353.DOI:10.1089/lap.2013.0138.
[11] 张震,乔国梁,叶茂,等.腹腔镜与开放Kasai手术治疗Ⅲ型胆道闭锁中期疗效的对比[J].临床小儿外科杂志,2016,15(2):156-158.DOI:10.3969/j.issn.1671-6353.2016.02.015. Zhang Z,Qiao GL,Ye M,et al.Mid-term outcomes of Laparoseopic laparoscopic versus open Kasai operation foron mid-term outcomes of infants with type Ⅲ biliary atresia[J].J Clin Ped Sur,2016,15(2):156-158.DOI:10.3969/j.issn.1671-6353.2016.02.015.
[12] 余莉,郭勇,柯海劲,等.腹腔镜与开腹Kasai手术对胆道闭锁疗效比较的Meta分析[J].中华小儿外科杂志,2019,40(7):613-621.DOI:10.3760/cma.j.issn.0253-3006.2019.07.008. Yu L,Guo Y,Ke HJ,et al.Laparoscopic portoenterostomy versus open portoenterostomy for children with biliary atresia:meta-analysis of comparative studies[J].Chin J Pediatr Surg,2019,40(7):613-621.DOI:10.3760/cma.j.issn.0253-3006.2019.07.008.
[13] 曹国庆,汤绍涛,周莹,等.机器人腹腔镜辅助Kasai手术治疗囊肿型胆道闭锁:国内首例报告[J].中国微创外科杂志,2021,21(5):446-449.DOI:10.3969/j.issn.1009-6604.2021.05.014. Cao GQ,Tang ST,Zhou Y,et al.Robotic-assisted Kasai operation for cystic biliary atresia:a first report in China[J].Chin J Minim Inva Surg,2021,21(5):446-449.DOI:10.3969/j.issn.1009-6604.2021.05.014.
[14] Wong KKY,Wong CWY.A review of long-term outcome and quality of life of patients after Kasai operation surviving with native livers[J].Pediatr Surg Int,2017,33(12):1283-1287.DOI:10.1007/s00383-017-4158-4.
[15] Bondoc AJ,Taylor JA,Alonso MH,et al.The beneficial impact of revision of Kasai portoenterostomy for biliary atresia:an institutional study[J].Ann Surg,2012,255(3):570-576.DOI:10.1097/SLA.0b013e318243a46e.
[16] Wada M,Nakamura H,Koga H,et al.Experience of treating biliary atresia with three types of portoenterostomy at a single institution:extended,modified Kasai,and laparoscopic modified Kasai[J].Pediatr Surg Int,2014,30(9):863-870.DOI:10.1007/s00383-014-3551-5.
[17] 王艺曦,陈军泽,张诚,等.腹腔镜Kasai手术在Ⅲ型胆道闭锁中的临床应用评价[J].临床小儿外科杂志,2021,20(4):340-347.DOI:10.12260/lcxewkzz.2021.04.008. Wang YX,Chen JZ,Zhang C,et al.Clinical evaluations of laparoscopic Kasai portoenterostomy for type Ⅲ biliary atresia[J].J Clin Ped Sur,2021,20(4):340-347.DOI:10.12260/lcxewkzz.2021.04.008.
[18] Patel HRH,Linares A,Joseph JV.Robotic and laparoscopic surgery:cost and training[J].Surg Oncol,2009,18(3):242-246.DOI:10.1016/j.suronc.2009.02.007.
[19] 兰蕴平,李春玲,黎嘉嘉,等.达芬奇机器人与传统开腹手术在老年上腹部外科疾病中的应用比较[J].中华普通外科杂志,2017,32(7):595-597.DOI:10.3760/cma.j.issn.1007-631X.2017.07.015. Lan YP,Li CL,Li JJ,et al.Da Vinci robot surgical system versus traditional open surgery for old elderspatients with upper abdominal surgical diseases:a case control study[J].Chin J Gen Surg,2017,32(7):595-597.DOI:10.3760/cma.j.issn.1007-631X.2017.07.015.
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备注/Memo
收稿日期:2022-12-6。
基金项目:湖北省卫生健康委员会科研项目(WJ2019M009); 儿童肝胆胰疾病研究室基金(2022FEYJS004)
通讯作者:闫学强,Email:yanxueqiang1@163.com