Lan Menglong,Zeng Jixiao,Xu Xiaogang,et al.Application of robotic-assisted surgery in reoperation of Hirschsprung’s disease:a single-center experience[J].Journal of Clinical Pediatric Surgery,2025,(06):512-518.[doi:10.3760/cma.j.cn101785-202408051-003]
机器人手术在巨结肠根治术后再手术中的应用:单中心经验
- Title:
- Application of robotic-assisted surgery in reoperation of Hirschsprung’s disease:a single-center experience
- 关键词:
- Hirschsprung病; 手术后并发症; 再手术; 机器人辅助腹腔镜手术; 儿童
- Keywords:
- Hirschsprung Disease; Postoperative Complications; Reoperation; Robotic-assisted Redo Pull-through Procedure; Child
- 摘要:
- 目的 评估巨结肠根治术后因并发症行机器人辅助再手术(robotic-assisted redo pull-through procedure,RARPT)的安全性及有效性,分析再手术的原因,总结手术经验。方法 回顾性分析2022年11月至2024年7月于广州医科大学附属妇女儿童医疗中心胃肠外科因巨结肠根治术后并发症而行RARPT的16例患儿临床资料。其中男10例、女6例;再次手术原因:便秘复发7例(获得性无神经节细胞1例、肌鞘残留2例、病变肠管残留4例),吻合口瘘6例(直肠阴道瘘2例,其他吻合口瘘4例),吻合口狭窄3例。RARPT具体手术方式包括Deloyers术7例,Swenson术7例(包括同时行残留肌鞘切除2例,吻合口瘘周围瘢痕肉芽组织清除5例),Swenson术+直肠阴道瘘修补术2例。结果 中位手术时间为315(200~510)min,出血量均小于20 mL,术后恢复饮食时间2~7 d,术后首次肛门排便时间1~3 d,术后住院时间8~14 d,术中无严重并发症出现,无一例中转开腹手术。1例住院期间出现不完全性肠梗阻,经保守治疗后好转出院。术后随访2~21个月,1例曾因不完全性肠梗阻经保守治疗痊愈,1例出现小肠结肠炎,经回流灌肠后好转,6例存在污粪现象。结论 RARPT治疗巨结肠根治术后并发症的安全性及有效性良好,近期效果满意。
- Abstract:
- Objective To evaluate the safety and effectiveness of robotic-assisted redo pull-through procedure (RAPT) due to complications after primary pull-through procedure (PT) for Hirschsprung’s disease (HSCR),examine the reasons for reoperation and summarize surgical experiences. Methods From November 2022 to July 2024,the relevant clinical data were retrospectively reviewed for 16 children undergoing RARPT for complications after primary PT for HSCR.There were 10 boys and 6 girls.The reasons for reoperation included recurrence of constipation (n=7) (acquired aganglionosis,n=1; residual rectal muscle cuff,n=2; residual aganglionic segment or transitional zone,n=4) and anastomotic fistula (n=6)(rectovaginal fistula,n=2; anastomotic stenosis,n=3).Reoperative approaches of RAPPT included Deloyers procedure (n=7),Swenson procedure (n=7) (simultaneous residual muscle sheath resection,n=2; removal of scar granulation tissue around anastomotic fistula,n=5) and Swenson procedure with repair of rectovaginal fistula (n=2). Results The median operative duration was 315(200-510) min,bleeding volume less than 20 ml,postoperative recovery time for eating and drinking (2-7) day,initial postoperative defecation time (1-3) day and postoperative hospital stay (8-14) day.No serious intraoperative complications occurred and there was no conversion into laparotomy.One child of incomplete intestinal obstruction improved after conservative measures and was discharged.Postoperative follow-up period was (2-21) month.One child was re-hospitalized for incomplete intestinal obstruction.Another case of enterocolitis improved after enema.There were 6 cases of soiling. Conclusions RARPT is both safe and effective for postoperative complications of HSCR.
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备注/Memo
收稿日期:2024-8-31。
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(202201010612、2023A03J0865);广州地区临床特色技术项目(2023C-TS48);卫生健康技术重点推广项目(XM202403895)
通讯作者:曾纪晓,Email:zengjixiao@163.com