Wen Jieyu,Xie Xiaolong,Xiang Bo.Comparison study of total robotic versus conventional robot-assisted choledochal cyst resection in children[J].Journal of Clinical Pediatric Surgery,2025,(06):525-531.[doi:10.3760/cma.j.cn101785-202503083-005]
全机器人与传统机器人辅助儿童胆总管囊肿切除术的对比研究
- Title:
- Comparison study of total robotic versus conventional robot-assisted choledochal cyst resection in children
- Keywords:
- Choledochal Cyst; Robotic Surgical Procedures; Robot Assisted Laparoscopic Surgery; Treatment Outcome; Intraoperative Complications; Postoperative Complications; Comparative Study
- 摘要:
- 目的 比较全机器人辅助儿童胆总管囊肿切除术(total robot assisted surgery,TRAS)和传统机器人辅助儿童胆总管囊肿切除术(conventional robot assisted surgery,CRAS)的疗效与安全性。方法 收集2021年1月至2024年6月于四川大学华西医院小儿外科接受TRAS和CRAS治疗的胆总管囊肿患儿临床资料,采用倾向性评分匹配(propensity score matching,PSM)控制年龄、身体质量指数(body mass index,BMI)等混杂因素,使手术方式成为唯一独立变量后,对比分析接受两种手术患儿的手术时长、术中出血量、手术中转率、术后肠功能恢复时间(肛门排气排便时间)、住院时间、术后短期(术后1个月)与长期(术后6个月)并发症发生率。结果 本研究中接受TRAS患儿36例,为TRAS组;接受CRAS患儿74例,为CRAS组。经过PSM后,最终两组各22例进入对比分析。两组基线资料差异均无统计学意义(P>0.05)。TRAS组手术时间[(238.36±50.37)min比(179.36±31.03)min,P< 0.01]长于CRAS组,术后肠功能恢复时间[(3.95±1.00)d比(4.73±0.94)d,P<0.01]和术后住院时间[(7.50±1.19)d 比(8.55±1.95)d,P=0.038]显著短于CRAS组,差异均有统计学意义(P<0.05)。结论 TRAS和CRAS均是治疗胆总管囊肿安全、有效的术式。相比于CRAS,TRAS可以加快术后肠道功能恢复,缩短住院时间。
- Abstract:
- Objective To compare the efficacy and safety of total robot-assisted surgery (TRAS) and conventional robot-assisted surgery (CRAS) for choledochal cyst resection in children. Methods Clinical data of pediatric patients undergoing TRAS or CRAS for choledochal cysts at the Department of Pediatric Surgery,West China Hospital,Sichuan University,from January 2021 to June 2024 were retrospectively collected.Propensity score matching (PSM) was applied to control for confounding factors such as age and body mass index (BMI),allowing surgical approach to be only independent variable.Outcomes including operative time,intraoperative blood loss,conversion rate,postoperative gastrointestinal function recovery (time to first anal gas and defecation),length of hospital stay,and short-term (1 month) and long-term complication rates (6-month) postoperative complication rates were compared between groups. Results A total of 36 patients received TRAS (TRAS group),and 74 patients received CRAS (CRAS group).After PSM,22 matched cases from each group were included in the final analysis.No statistically significant differences were found in baseline characteristics between the two groups (P>0.05).Compared with the CRAS group,the TRAS group had significantly longer operative time [(238.36±50.37) min vs.(179.36±31.03) min,P<0.01],but shorter postoperative gastrointestinal recovery time[(3.95±1.00) days vs.(4.73±0.94) days,P<0.01] and shorter postoperative hospital stay[(7.50±1.19) days vs.(8.55±1.95) days,P=0.038],with all differences being statistically significant (P<0.05). Conclusions Both TRAS and CRAS are safe and effective surgical methods for treating choledochal cysts in children.Compared with CRAS,TRAS may accelerate postoperative gastrointestinal recovery and reduce hospital stay.
参考文献/References:
[1] de Vries JS,de Vries S,Aronson DC,et al.Choledochal cysts:age of presentation,symptoms,and late complications related to Todani’s classification[J].J Pediatr Surg,2002,37(11):1568-1573.DOI:10.1053/jpsu.2002.36186.
[2] Xie SQ,Huang YB,He YB,et al.Outcomes and comparations of pediatric surgery about choledochal cyst with robot-assisted procedures,laparoscopic procedures,and open procedures:a meta-analysis[J].Front Pediatr,2022,10:968960.DOI:10.3389/fped.2022.968960.
[3] Chi SQ,Cao GQ,Li S,et al.Outcomes in robotic versus laparoscopic-assisted choledochal cyst excision and hepaticojejunostomy in children[J].Surg Endosc,2021,35(9):5009-5014.DOI:10.1007/s00464-020-07981-y.
[4] Zhang MX,Chi SQ,Cao GQ,et al.Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children:a systematic review and proportional meta-analysis[J].Surg Endosc,2023,37(1):31-47.DOI:10.1007/s00464-022-09442-0.
[5] Xie XL,Feng LW,Li KW,et al.Learning curve of robot-assisted choledochal cyst excision in pediatrics:report of 60 cases[J].Surg Endosc,2021,35(6):2690-2697.DOI:10.1007/s00464-020-07695-1.
[6] Xie XL,Li KW,Xiang B.Total versus conventional robotic-assisted cyst excisions and hepaticojejunostomies in children with choledochal cysts:a case-control study[J].J Robot Surg,2023,17(3):869-876.DOI:10.1007/s11701-022-01484-9.
[7] Zhang MX,Huang JS,Jin Z,et al.Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia:a propensity score matching analysis[J].Int J Surg,2024,110(2):891-901.DOI:10.1097/JS9.0000000000000889.
[8] Schober P,Vetter TR.Propensity score matching in observational research[J].Anesth Analg,2020,130(6):1616-1617.DOI:10.1213/ANE.0000000000004770.
[9] 罗洋,谢小龙,向波.儿童腔镜辅助胆总管囊肿切除术胆肠吻合处理策略研究[J].中华腔镜外科杂志(电子版),2024,17(2):70-75.DOI:10.3877/cma.j.issn.1674-6899.2024.02.002. Luo Y,Xie XL,Xiang B.Strategy of choledochoenterostomy in laparoscopic assisted choledochal cyst excision in children[J].Chin J Laparosc Surg (Electron Ed),2024,17(2):70-75.DOI:10.3877/cma.j.issn.1674-6899.2024.02.002.
[10] Cheng JW,Yu Q,Fu JL,et al.Non-stapled,total laparoscopic Roux-en-Y anastomosis:a safe and effective procedure for radical pediatric choledochal cyst excision[J].Surg Open Sci,2024,17:49-53.DOI:10.1016/j.sopen.2023.12.012.
[11] 蔡多特,陈青江,章立峰,等.达芬奇技术与传统腹腔镜技术在胆总管囊肿根治术中应用的对比研究[J].临床小儿外科杂志,2022,21(1):51-57.DOI:10.3760/cma.j.cn.101785-202012066-010. Cai DT,Chen QJ,Zhang LF,et al.Comparative study of Da Vinci technique versus traditional laparoscopic technique in the treatment of choledochal cyst[J].DOI:10.3760/cma.j.cn.101785-202012066-010.
[12] Wen Z,Liang HY,Liang JK,et al.Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children:CUSUM analysis of a single surgeon’s experience[J].Surg Endosc,2017,31(2):778-787.DOI:10.1007/s00464-016-5032-5.
[13] Woo R,Le D,Albanese CT,et al.Robot-assisted laparoscopic resection of a type I choledochal cyst in a child[J].J Laparoendosc Adv Surg Tech A,2006,16(2):179-183.DOI:10.1089/lap.2006.16.179.
[14] Pawar J,Chinnusamy P,Soundappan S,et al.Comparison of perioperative surgical outcomes following total robotic and total laparoscopic Roux-en Y hepaticojejunostomy for choledochal cyst in paediatric population:a preliminary report from a tertiary referral centre[J].Pediatr Surg Int,2023,39(1):139.DOI:10.1007/s00383-023-05414-0.
[15] 中华人民共和国国家卫生健康委员会办公厅.体重管理指导原则(2024年版)[EB/OL].(2024-12-05)https://www.nhc.gov.cn/ylyjs/zcwj/202412/75cb79c171c94def9e768193e65484f7/files/1736390749000_59785.pdf. Office of the National Health Commission of the People’s Republic of China.Weight management guidelines (2024 edition)[EB/OL].(2024-12-05) https://www.nhc.gov.cn/ylyjs/zcwj/202412/75cb79c171c94def9e768193e65484f7/files/1736390749000_59785.pdf.
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备注/Memo
收稿日期:2025-3-23。
基金项目:四川大学华西医院专职博士后基金(2024HXBH152)
通讯作者:向波,Email:xb_scu.edu@hotmail.com