Zhao Yang,Zhou Huixia,Ma Lifei,et al.Preliminary experience of robot-assisted laparoscopic adrenal mass resection in children[J].Journal of Clinical Pediatric Surgery,2021,20(08):712-717.[doi:10.12260/lcxewkzz.2021.08.003]
机器人辅助腹腔镜技术应用于儿童肾上腺肿物切除术的初步经验
- Title:
- Preliminary experience of robot-assisted laparoscopic adrenal mass resection in children
- Keywords:
- Robotic Surgical Procedures; Laparoscopy; Adrenalectomy; Child
- 分类号:
- R736.6;R726.1
- 摘要:
- 目的 探讨机器人辅助腹腔镜技术应用于儿童肾上腺肿物切除术的安全性和可行性。方法 回顾性分析2017年6月至2019年6月由解放军总医院第七医学中心儿童泌尿外科收治的10例采用机器人辅助腹腔镜技术完成肾上腺肿物切除术患者的临床资料，其中男4例，女6例。年龄1~96个月，平均年龄37.9个月。双侧肾上腺肿物1例，右侧肾上腺肿物7例，左侧肾上腺肿物2例。1例通过临床表现及产前检查发现；4例因脐周或上腹疼痛发现；5例无症状，通过超声探查发现。所有患者术前经腹部增强CT或增强MRI证实为肾上腺占位，均不存在基于影像学定义的危险因子（image-defined risk factors，IDRFs）。结果 10例均采用机器人辅助腹腔镜技术经腹腔途径行肾上腺肿物切除术，术中无中转开放手术病例。平均腹腔内操作时间145.2 min （97~220 min），平均出血量22 mL （10~30 mL），肿物最大直径平均为4.7 cm （3~8 cm），肿物平均重量38.3 g （5~76 g）。术后病理类型：肾上腺囊肿1例，肾上腺成熟畸胎瘤3例，节细胞神经母细胞瘤3例，神经节细胞瘤3例。术后2例转至儿童血液肿瘤科化疗。术后平均进食时间3.8 d （3~7 d），平均引流管留置时间6 d （3~15 d）。1例术后发热10 d，超声证实存在肝肾间隙积液。术后平均住院时间7 d （4~20 d），出院后平均随访12.5个月（6~20个月），无一例肿瘤复发。结论 机器人辅助腹腔镜下肾上腺肿物切除术可以安全、有效地应用于部分儿童肾上腺肿物的治疗。
- Abstract:
- Objective To explore the feasibility, safety and efficacy of robot-assisted laparoscopic adrenalectomy (RALA) with semi-hidden incision techniquein for pediatric adrenal mass. Methods Ten patients with adrenal mass underwent RALA with semi-hidden incision technique from June 2017 to June 2019. There were 6 girls and 4 boys with an average age of 37.9(1-96) months. The involved side was bilateral (n=1), left (n=4) and right (n=6). There were antenatal ultrasonic detection (n=1), abdominal pain (n=4), ultrasonic detection (n=5). Preoperative computed tomography (CT) or magnetic resonance imaging (MRI) revealed adrenal mass without image-defined risk factors. Results All procedures were successfully performed without any conversion into open surgery. The average operative duration was 145.2(97-220) min, the mean estimated volume of blood loss 22(10-30) ml and the mean tumor diameter 4.7(3-8) cm and the mean tumor weight 38.3(5-76) gram. Histopathological examination hinted at cyst (n=1), mature teratoma (n=3), ganglioneuroma (n=3) and ganglioneuroblastoma (n=3). One case developed fever for 10 days and ultrasonic decected effusion between liver and kidney. Others recovered well postoperatively. The mean hospital stay was 7(4-20) days, the mean days of removing drainage 6(3-15) days and the mean days of resuming a solid oral diet 3.8(3-7) days. During a mean follow-up period of 12.5(6-20) months, there was no onset of recurrence or metastasis. Conclusion Robotic-assisted laparoscopic adrenalectomy is both safe and effective for pediatric adrenal tumor.
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备注/Memo
收稿日期:2020-07-20。
基金项目:卫生部行业科研专项（编号：201402007）；首都卫生发展科研专项（编号：2016—2—5091）
通讯作者:周辉霞,Email:huixia99999@163.com