Li Wei,Luo Jingchu,Hu Hai,et al.Clinical efficacy of enhanced recovery after surgery plus robot-assisted laparoscopy for congenital biliary dilatation in children[J].Journal of Clinical Pediatric Surgery,2025,(08):758-763.[doi:10.3760/cma.j.cn101785-202402027-010]
加速康复外科理念联合机器人腹腔镜手术治疗小儿先天性胆管扩张症
- Title:
- Clinical efficacy of enhanced recovery after surgery plus robot-assisted laparoscopy for congenital biliary dilatation in children
- Keywords:
- Robot; Enhanced Recovery After Surgery; Congenital Biliary Dilatation; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)理念联合机器人辅助腹腔镜手术治疗小儿先天性胆管扩张症的临床效果。方法 回顾性分析2015年1月至2021年12月广西医科大学第一附属医院收治的81例先天性胆管扩张症患儿临床资料,按照收治时段分为三组。A组26例,围手术期采用传统处理方法,手术方法为常规腹腔镜手术;B组26例,围手术期采用加速康复外科管理模式,手术方法为常规腹腔镜手术;C组29例,围手术期采用加速康复外科管理模式,手术方法为机器人辅助腹腔镜手术。比较三组患儿的手术时间、术后炎症指标、术后疼痛评分、术后住院时间及术后并发症发生率。结果 A组、B组和C组的手术时间分别为(239.3±32.6)min、(234.8±29.3)min和(195.7±38.6)min;术后第1天C-反应蛋白水平分别为(18.0±4.3)mg/L、(16.7±4.5)mg/L和(14.5±3.3)mg/L;术后首次喂奶时间分别为(58.9±6.1)h、(27.4±2.7)h和(28.7±2.4)h;术后停止补液时间分别为(7.7±0.9)d、(6.4±0.5)d和(6.0±0.6)d;术后住院时间分别为(9.7±1.0)d、(7.7±0.8)d和(6.8±0.8)d;三组上述指标差异均有统计学意义(P＜0.05)。A组、B组和C组术后第1天疼痛评分分别为(3.1±0.7)分、(2.6±0.4)分和(2.5±0.5)分;第2天疼痛评分分别为(2.8±0.8)分、(2.2±0.5)分和(2.1±0.4)分;三组间术后第1天、第2天疼痛评分差异均有统计学意义(P＜0.05)。A组术后出现胆漏合并出血1例,上呼吸道感染1例,非计划再次手术1例;B组术后出现胆漏1例,非计划再手术1例;C组术后出现肠梗阻1例;上呼吸道感染1例,三组间术后并发症差异无统计学意义(P＞0.05)。结论 加速康复外科理念联合机器人辅助腹腔镜手术治疗小儿先天性胆管扩张症,在熟练掌握机器人手术技术后,可以缩短手术时间,减轻手术应激,加速术后康复。
- Abstract:
- Objective To explore the efficacies of combining perioperative measures of enhanced recovery after surgery (ERAS) with robot-assisted laparoscopy in children with congenital biliary dilatation (CBD). Methods Between January 2015 and December 2021,retrospective analysis was performed for the relevant clinical data of 81 hospitalized CBD children.They were categorized into three groups based upon specific treatment options.Group A underwent traditional perioperative management with conventional laparoscopy (n=26),group B (n=26) ERAS management during perioperative period with conventional laparoscopy while group C (n=29) ERAS management during perioperative period with robot-assisted laparoscopy.Operative durations,postoperative inflammatory parameters,postoperative pain scores,postoperative hospitalization stay and postoperative complication rates were compared among three groups. Results Operative durations of groups A,B and C were (239.3±32.6),(234.8±29.3) and (195.7±38.6) min.At Day 1 post-operation,C-reactive protein (CRP) level was (18.0±4.3),(16.7±4.5) and (14.5±3.3) mg/L.Postoperative time to initial feeding was (58.9±6.1),(27.4±2.7) and (28.7±2.4) hour while postoperative time to stop fluid supplementation was (7.7±0.9),(6.4±0.5) and (6.0±0.6) day.Length of postoperative hospital stay was (9.7±1.0),(7.7±0.8) and (6.8±0.8) day.Significant differences existed among three groups (P<0.05).At Day 1 post-operation,pain scores of groups A,B and C were (3.1±0.7),(2.6±0.4) and (2.5±0.5).At Day 2 post-operation,scores were (2.8±0.8),(2.2±0.5) and (2.1±0.4) with statistically significant differences among three groups (P<0.05).In group A,there were bile leakage with hemorrhage (n=1),upper respiratory tract (URT) infection (n=1) and unplanned reoperation (n=1);In group B,bile leakage (n=1) and unplanned reoperation (n=1);In group C,intestinal obstruction (n=1) and URT infection (n=1).No statistically significant differences in postoperative complications existed among three groups (P>0.05). Conclusions For CBD children,combining ERAS measures with robot-assisted laparoscopy offers the advantages of shortening operative duration,lowering surgical stresses,alleviating pain and promoting postoperative recovery.The above goals may be achieved after mastering the robotic surgical skills.
参考文献/References:
[1] Ishibashi H,Shimada M,Kamisawa T,et al.Japanese clinical practice guidelines for congenital biliary dilatation[J].J Hepatobiliary Pancreat Sci,2017,24(1):1-16.DOI:10.1002/jhbp.415.
[2] 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 laparoscopy for choledochal cyst[J].J Clin Ped Sur,2022,21(1):51-57.DOI:10.3760/cma.j.cn.101785-202012066-010.
[3] 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.
[4] Zhang B,Fang YF,Wu DM,et al.Efficacy analysis of enhanced recovery after surgery in laparoscopic-assisted radical resection of type I choledochal cyst[J].Front Pediatr,2023,11:1191065.DOI:10.3389/fped.2023.1191065.
[5] 李伟,苏成,王从军,等.小儿外科日间手术在综合医院应用模式的可行性研究[J].中华小儿外科杂志,2020,41(8):710-715.DOI:10.3760/cma.j.cn421158-20200211-00065. Li W,Su C,Wang CJ,et al.Feasibility study of pediatric day surgery at a general hospital[J].Chin J Pediatr Surg,2020,41(8):710-715.DOI:10.3760/cma.j.cn421158-20200211-00065.
[6] Braungart S,Siminas S.Early enteral nutrition following gastrointestinal surgery in children:a systematic review of the literature[J].Ann Surg,2020,272(2):377-383.DOI:10.1097/SLA.0000000000003128.
[7] Jing W,Wu SY,Gao SZ,et al.Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy:a propensity score-weighted analysis of 428 consecutive patients[J].Int J Surg,2024,110(1):229-237.DOI:10.1097/JS9.0000000000000786.
[8] 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.
[9] 张淇钧,谢小龙,杨家印,等.机器人手术与腹腔镜手术治疗小儿胆总管囊肿中短期随访的对比研究[J].中华小儿外科杂志,2023,44(7):586-591.DOI:10.3760/cma.j.cn421158-20220608-00425. Zhang QJ,Xie XL,Yang JY,et al.Short/medium-term follow-ups of robotic surgery versus laparoscopy for pediatric choledochal cysts[J].Chin J Pediatr Surg,2023,44(7):586-591.DOI:10.3760/cma.j.cn421158-20220608-00425.
[10] Wang Z,Guan XS,Yu JK,et al.Modified single-port versus multiport laparoscopic choledochal cysts excision and Roux-en-Y hepaticojejunostomy:a retrospective comparative cohort study[J].Transl Pediatr,2022,11(11):1831-1839.DOI:10.21037/tp-22-557.
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备注/Memo
收稿日期:2024-2-27。
基金项目:广西医疗卫生适宜技术开发与推广应用项目(S2022068)
通讯作者:罗意革,Email:lyg6829@163.com