Zhu Menglei,Sun Yi,Zhu Jie,et al.Efficacy and safety of robotic versus laparoscopic Kasai portoenterostomy for biliary atresia: a single-center cohort study[J].Journal of Clinical Pediatric Surgery,2025,(11):1011-1016.[doi:10.3760/cma.j.cn101785-202508015-003]
机器人辅助Kasai术与腹腔镜Kasai术治疗胆道闭锁的单中心队列研究
- Title:
- Efficacy and safety of robotic versus laparoscopic Kasai portoenterostomy for biliary atresia: a single-center cohort study
- Keywords:
- Biliary Atresia; Laparoscope; Robotics; Surgical Procedures; Operative; Child
- 摘要:
- 目的 比较机器人辅助Kasai术(robotic-assisted Kasai portoenterostomy,RAKPE)与腹腔镜Kasai术(laparoscopic Kasai portoenterostomy,LKPE)治疗胆道闭锁的效果与安全性,为优化微创手术策略提供依据。方法 回顾性分析2021年10月至2025年1月于苏州大学附属儿童医院接受微创Kasai术的23例胆道闭锁患儿临床资料,其中LKPE组(接受LKPE治疗)15例,RAKPE(接受RAKPE治疗)组8例。观察指标包括人口学特征、围手术期指标、术后并发症及胆管炎发生率、术后6个月黄疸清除率及肝移植率,并对术前及术后1周肝功能指标进行纵向比较。结果 RAKPE组手术时间[297.00(273.75,348.75)min]显著长于LKPE组[225.00(197.50,252.50)min],差异有统计学意义(P<0.05);但术中失血量、术后住院时间及术后进食时间差异无统计学意义(P>0.05);术后并发症发生率(2/8比0/15)及胆管炎发生率(6/8比7/15)差异无统计学意义(P>0.05);术后6个月黄疸清除率(5/8比9/15)及肝移植率(3/8比6/15)差异无统计学意义(P>0.05)。肝功能纵向比较结果显示,LKPE组术后总胆红素[122.40(94.35,125.75)mol/L]、直接胆红素[86.40(72.90,97.90)mol/L]及RAKPE组术后直接胆红素[62.95(53.42,92.53)mol/L]较术前显著下降,差异有统计学意义(P<0.05),但两组间肝功能指标差异无统计学意义(P>0.05)。结论 RAKPE与LKPE治疗胆道闭锁的疗效及安全性相当,但RAKPE手术时间较长。
- Abstract:
- Objective To compare the efficacy and safety of robotic-assisted Kasai portoenterostomy (RAKPE) versus laparoscopic Kasai portoenterostomy (LKPE) in the treatment of biliary atresia (BA) so as to provide rationales for optimizing mini-invasive surgical strategies for BA. Methods A retrospective analysis was conducted for the relevant clinical data of 23 BA children undergoing mini-invasive Kasai procedures between October 2021 and January 2025.They were assigned into LKPE group (n=15) and RAKPE group (n=8).Demographic profiles,perioperative metrics,postoperative complications,cholangitis incidence,jaundice clearance rate at Month 6 post-operation and liver transplantation rate were recorded.Longitudinal comparisons of liver function parameters were performed preoperatively and 1 week postoperatively.Mann-Whitney U and Fisher’s exact tests were employed for statistical processing. Results Baseline profiles were comparable between two groups.Operative duration was significantly longer in RAKPE group than that in LKPE group[297.00(273.75,348.75) vs. 225.00(197.50,252.50)min].However,no significant differences existed in intraoperative volume of hemorrhage,postoperative hospitalization stay or time to postoperative feeding (P>0.05).The incidence of postoperative complications (2/8 vs.0/15) and cholangitis (6/8 vs.7/15) showed no significant differences (P>0.05).Similarly,jaundice clearance rate at Month 6 (5/8 vs.9/15) and liver transplantation rate (3/8 vs.6/15) were not significantly different (P>0.05).A longitudinal comparison of liver function outcomes demonstrated that postoperative total bilirubin[122.40(94.35,125.75)mol/L]and direct bilirubin[86.40(72.90,97.90)mol/L]in LKPE group,as well as postoperative direct bilirubin[62.95(53.42,92.53)mol/L]in RAKPE group,declined markedly as compared to preoperative levels (P<0.05).However,no statistically significant inter-group differences existed in liver function parameters (P>0.05). Conclusions RAKPE and LKPE have demonstrated comparable therapeutic efficacy and safety for BA.RAKPE has a longer operative duration.No significant differences in postoperative complications,cholangitis incidence,jaundice clearance or liver transplantation rate were observed between two techniques.
参考文献/References:
[1] Tam PKH, Wells RG, Tang CSM, et al.Biliary atresia[J]. Nat Rev Dis Primers, 2024, 10(1): 47. DOI: 10.1038/s41572-024-00533-x.
[2] Zhang YR, Liu SW, Yang QH, et al.Comparison of different Kasai portoenterostomy techniques in the outcomes of biliary atresia:a systematic review and network meta-analysis[J]. Pediatr Surg Int, 2024, 41(1): 6. DOI: 10.1007/s00383-024-05920-9.
[3] Lishuang M, Zhen C, Guoliang Q, et al.Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia:a systematic review and meta-analysis of comparative studies[J]. Pediatr Surg Int, 2015, 31(3): 261-269. DOI: 10.1007/s00383-015-3662-7.
[4] Aspelund G, Ling SC, Ng V, et al.A role for laparoscopic approach in the treatment of biliary atresia and choledochal cysts[J]. J Pediatr Surg, 2007, 42(5): 869-872. DOI: 10.1016/j.jpedsurg.2006.12.052.
[5] Li B, Chen WB, Xia SL.A comparison of laparoscopic-modified Kasai versus conventional open Kasai for biliary atresia in infants:a single-center experience[J]. J Laparoendosc Adv Surg Tech A, 2023, 33(2): 226-230. DOI: 10.1089/lap.2022.0339.
[6] Autorino R, Zargar H, Kaouk JH.Robotic-assisted laparoscopic surgery:recent advances in urology[J]. Fertil Steril, 2014, 102(4): 939-949. DOI: 10.1016/j.fertnstert.2014.05.033.
[7] Kawka M, Fong Y, Gall TMH.Laparoscopic versus robotic abdominal and pelvic surgery:a systematic review of randomised controlled trials[J]. Surg Endosc, 2023, 37(9): 6672-6681. DOI: 10.1007/s00464-023-10275-8.
[8] 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.
[9] Davenport M, Madadi-Sanjani O, Chardot C, et al.Surgical and medical aspects of the initial treatment of biliary atresia:position paper[J]. J Clin Med, 2022, 11(21): 6601. DOI: 10.3390/jcm11216601.
[10] 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.
[11] Wong KKY, Chung PHY, Chan KL, et al.Should open Kasai portoenterostomy be performed for biliary atresia in the era of laparoscopy?[J]. Pediatr Surg Int, 2008, 24(8): 931-933. DOI: 10.1007/s00383-008-2190-0.
[12] Hussain MH, Alizai N, Patel B.Outcomes of laparoscopic Kasai portoenterostomy for biliary atresia:a systematic review[J]. J Pediatr Surg, 2017, 52(2): 264-267. DOI: 10.1016/j.jpedsurg.2016.11.022.
[13] Sokol RJ, Shepherd RW, Superina R, et al.Screening and outcomes in biliary atresia:summary of a National Institutes of Health workshop[J]. Hepatology, 2007, 46(2): 566-581. DOI: 10.1002/hep.21790.
[14] 任玉奇, 闫学强.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[J]. 临床小儿外科杂志, 2023, 22(12): 1151-1155. DOI: 10.3760/cma.j.cn101785-202212015-011. Ren YQ, Yan XQ.Comparison of early efficacies between Da Vinci’s robot surgery versus open Kasai surgery in the treatment of biliary atresia[J]. DOI: 10.3760/cma.j.cn101785-202212015-011.
[15] 朱世春, 刘振勇, 李炳.腹腔镜改良Kasai手术与传统开放Kasai手术治疗小儿胆道闭锁的对比研究[J]. 腹腔镜外科杂志, 2023, 28(11): 855-858, 866. DOI: 10.13499/j.cnki.fqjwkzz.2023.11.855. Zhu SC, Liu ZY, Li B.Comparative study of laparoscopic-modified Kasai versus conventional open Kasai for biliary atresia in infants[J]. J Laparosc Surg, 2023, 28(11): 855-858, 866. DOI: 10.13499/j.cnki.fqjwkzz.2023.11.855.
[16] 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.Comparison of mid-term outcomes for laparoseopic versus open Kasai operation in 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.
[17] Shirota C, Hinoki A, Tainaka T, et al.Laparoscopic Kasai portoenterostomy can be a standard surgical procedure for treatment of biliary atresia[J]. World J Gastrointest Surg, 2022, 14(1): 56-63. DOI: 10.4240/wjgs.v14.i1.56.
[18] Ji Y, Yang KY, Zhang XP, et al.The short-term outcome of modified laparoscopic Kasai portoenterostomy for biliary atresia[J]. Surg Endosc, 2021, 35(3): 1429-1434. DOI: 10.1007/s00464-020-07530-7.
[19] 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.
[20] 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.
[21] 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:first report in China[J]. Chin J Min Inv Surg, 2021, 21(5): 446-449. DOI: 10.3969/j.issn.1009-6604.2021.05.014.
[22] Zhang MX, Cao GQ, Li XY, et al.Robotic-assisted Kasai portoenterostomy for biliary atresia[J]. Surg Endosc, 2023, 37(5): 3540-3547. DOI: 10.1007/s00464-022-09855-x.
[23] Zhang MX, Tang JF, Zheng ZB, et al.Comparison of surgical results and technical performance between robotic and laparoscopic approaches for Kasai portoenterostomy in biliary atresia:a multicenter retrospective study[J]. Surg Endosc, 2025, 39(2): 1128-1139. DOI: 10.1007/s00464-024-11452-z.
[24] 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.
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备注/Memo
收稿日期:2025-8-6。
基金项目:苏州市民生科技医疗卫生应用基础研究项目(SYW2024106);苏州市姑苏卫生人才项目(GSWS2022060);苏州医学创新应用研究项目(SKYD2023128)
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