Wang Peng,Huang Soujiang,Lyu Chenjie,et al.Robotic-assisted surgery in neonates with congenital intestinal malrotation[J].Journal of Clinical Pediatric Surgery,2023,22(09):876-880.[doi:10.3760/cma.j.cn101785-202203003-015]
机器人手术系统在新生儿先天性肠旋转不良手术中的应用
- Title:
- Robotic-assisted surgery in neonates with congenital intestinal malrotation
- Keywords:
- Robotic Surgical Procedures; Duodenal Obstruction; Surgical Procedures; Operative; Infant; Newborn
- 摘要:
- 目的 探讨机器人手术系统在新生儿先天性肠旋转不良手术中的应用价值及效果。方法 回顾性分析 2020年8月至2021年6月由浙江大学医学院附属儿童医院新生儿外科收治的15例经机器人辅助治疗的新生儿先天性肠旋转不良患儿临床资料、手术相关资料、术后恢复情况以及术后6~12个月的随访资料,分析患儿术前、术中以及预后情况,总结器人手术在肠旋转不良应用的相关经验。结果 15例患儿中男13例,女2例;胎龄36+2~40+4周;早产儿2例,足月儿13例;剖腹产7例,顺产8例;手术时日龄(11.7±5.9)d;手术时体重(3 065±377)g;7例术前超声检查提示肠扭转720°,5例术前B超提示肠扭转540°,3例术前B超提示肠扭转360°;12例胆汁性呕吐,3例非胆汁性呕吐;4例合并房间隔缺损,2例合并动脉导管未闭,2例合并室间隔缺损,其余7例未合并心脏畸形。15例均在机器人辅助下完成手术,无一例中转开腹。手术时间(57±8)min,装机时间为(14 ±3)min。术中气腹压力为(5.6±0.3)mmHg;呼气末PaCO2为(38.4±4.3)mmHg,估计出血量1~3 mL。术后撤离呼吸机时间为(5.2±1.8)h。初次经口进食时间为术后(3.1±1.2)d,足量进食时间为术后(7.2±1.8)d,住院时间为(12.1±2.7)d。1例术后因局部肠粘连导致肠梗阻再次行手术治疗,1例因肠动力异常住院时间达27 d,其余13例恢复良好,无呕吐、腹胀、切口感染等术后并发症发生。出院后随访结果提示15例均喂养良好,手术切口愈合满意,生长发育正常。结论 机器人手术系统在新生儿先天性肠旋转不良手术中应用安全、可行,可以取得良好的治疗效果。
- Abstract:
- Objective To summarize the outcomes of robotic-assisted surgical system for congenital intestinal malrotation (CIM).Methods From August 2020 to June 2021,15 CIM neonates underwent robotic-assisted surgery.The relevant clinical data、Surgery-related data,postoperative recovery were collected retrospectively.By analyzing the preoperative,intraoperative and prognosis of the children,The robotic-assisted surgical system for congenital intestinal malrotation was summarized.Results Of the 15 children,13 were male and 2 female; gestational age 36+2 to 40+4 weeks; 2 premature infants,13 term infants; 7 caesarean section,8 vaginal delivery; operation age (11.7±5.9) d; weight (3 065±377) g; Preoperative ultrasound test showed that 7 cases with volvulus 720,5 cases with volvulus 540,3 cases with volvulus 360; 12 cases with biliary vomiting,3 cases with non-biliary vomiting; 4 cases with combined atrial septal defect,2 cases with complicated patent artery duct,2 cases with combined ventricular septal defect and the remaining 7 cases without cardiac malformation。All of them underwent robotic-assisted procedures without any conversion into open surgery.The average operative duration was (57±8) min,the average system installation time (14±3) min,the average intra-abdominal pressure (IAP)(5.6±0.3)mmHg and the average end-tidal carbon dioxide (38.4±4.3) mmHg.The intra-operative bleeding volume was from 1 to 3 ml,the average mechanical ventilation time (5.2±1.8) hours,the average Initial oral feeding time (3.1±1.2) days,the average sufficient feeding time (7.2±1.8) days and the average hospitalization time (12.1±2.7) days.One child was re-operated due to an obstruction of focal intestinal adhesion.Another case was hospitalized for 27 days and it was significantly longer than other children due to abnormal intestinal motility.The remainders recovered well with no postoperative complications such as vomiting,abdominal distension or incision infection.During postoperative follow-ups,all of them were well fed with satisfactory surgical incision healing and normal growth and development.Conclusion Robot-assisted surgery is both safe and feasible for neonatal CIM and offers excellent outcomes.
参考文献/References:
[1] Kumar P,Kumar C,Pandey PR,et al.Congenital duodenal obstruction in neonates:over 13 years’ experience from a single centre[J].J Neonatal Surg,2016,5(4):50.DOI:10.21699/jns.v5i4.461.
[2] 李索林,温哲,时保军,等.小儿腹腔镜下先天性十二指肠梗阻的诊治[J].中华小儿外科杂志,2005,26(4):183-185.DOI:10.3760/cma.j.issn.0253-3006.2005.04.005. Li SL,Wen Z,Shi BJ,et al.Laparoscopic diagnosis and treatment of congenital duodenal obstruction in children[J].Chin J Pediatr Surg,2005,26(4):183-185.DOI:10.3760/cma.j.issn.0253-3006.2005.04.005.
[3] 张书豪,高志刚,钭金法,等.机器人手术在小儿外科领域的应用现状[J].临床小儿外科杂志,2021,20(8):701-707.DOI:10.12260/lcxewkzz.2021.08.001. Zhang SH,Gao ZG,Tou JF,et al.Current applications of robotic procedures during pediatric surgery[J].J Clin Ped Sur,2021,20(8):701-707.DOI:10.12260/lcxewkzz.2021.08.001.
[4] 汤绍涛.机器人手术在小儿外科中的发展现状及展望[J].机器人外科学杂志(中英文),2021,2(4):241-247.DOI:10.12180/j.issn.2096-7721.2021.04.001. Tang ST.Current status and future prospects of robot-assisted surgery in children:[J].Chin J Robot Surg,2021,2(4):241-247.DOI:10.12180/j.issn.2096-7721.2021.04.001.
[5] 黄格元,蓝传亮,刘雪来,等.达芬奇机器人在小儿外科手术中的应用(附20例报告)[J].中国微创外科杂志,2013,13(1):4-8.DOI:10.3969/j.issn.1009-6604.2013.01.002. Huang GY,Lan CL,Liu XL,et al.Da Vinci robotic system for pediatric surgery:a report of 20 cases[J].Chin J Minim Inva Surg,2013,13(1):4-8.DOI:10.3969/j.issn.1009-6604.2013.01.002.
[6] 胡书奇,吕成杰,韩一江,等.腹腔镜技术在不同出生体重新生儿十二指肠梗阻中的应用研究[J].临床小儿外科杂志,2020,19(9):800-805.DOI:10.3969/j.issn.1671-6353.2020.09.008. Hu SQ,Lyu CJ,Han YJ,et al.Application of laparoscopic technique for duodenal obstruction in neonates with different birth weights[J].J Clin Ped Sur,2020,19(9):800-805.DOI:10.3969/j.issn.1671-6353.2020.09.008.
[7] 陈兰萍,任红霞,陈淑芸,等.腹腔镜诊治小婴儿肠旋转不良的探讨[J].临床小儿外科杂志,2004,3(6):409-411.DOI:10.3969/j.issn.1671-6353.2004.06.003. Chen LP,Ren HX,Chen SY,et al.Diagnosis and therapy of congenital intestinal malrotation by laparoscopy in neonates and toddlers[J].J Clin Ped Sur,2004,3(6):409-411.DOI:10.3969/j.issn.1671-6353.2004.06.003.
[8] 阳历,张茜,汤绍涛.手术机器人在小儿外科领域应用的机遇与挑战[J].中华小儿外科杂志,2015,36(10):791-794.DOI:10.3760/cma.j.issn.0253-3006.2015.10.019. Yang L,Zhang Q,Tang ST.Opportunities and challenges of surgical robot application in the field of pediatric surgery[J].Chin J Pediatr Surg,2015,36(10):791-794.DOI:10.3760/cma.j.issn.0253-3006.2015.10.019.
[9] 李芹,刘文英.人工智能在小儿外科领域的应用及展望[J].中华小儿外科杂志,2021,42(1):76-81.DOI:10.3760/cma.j.cn421158-20190813-00496. Li Q,Liu WY.Applications and future prospects of artificial intelligence in pediatric surgery[J].Chin J Pediatr Surg,2021,42(1):76-81.DOI:10.3760/cma.j.cn421158-20190813-00496.
[10] 周辉霞,曹华林.机器人辅助腹腔镜手术在小儿泌尿外科的应用与现状[J].中华腔镜外科杂志(电子版),2018,11(2):72-76.DOI:10.3877/cma.j.issn.1674-6899.2018.02.003. Zhou HX,Cao HL.Application and current status of robot-assisted laparoscopy during pediatric urology[J].Chin J Laparosc Surg (Electron Ed),2018,11(2):72-76.DOI:10.3877/cma.j.issn.1674-6899.2018.02.003.
[11] Avery DI,Herbst KW,Lendvay TS,et al.Robot-assisted laparoscopic pyeloplasty:multi-institutional experience in infants[J].J Pediatr Urol,2015,11(3):139.e1-139.e5.DOI:10.1016/j.jpurol.2014.11.025.
[12] 冯翠竹,李龙,马继东,等.经脐单部位腹腔镜治疗新生儿十二指肠梗阻[J].中国微创外科杂志,2019,19(1):50-52.DOI:10.3969/j.issn.1009-6604.2019.01.014. Feng CZ,Li L,Ma JD,et al.Transumbilical single-site laparoscopy for neonatal duodenal obstruction[J].Chin J Minim Inva Surg,2019,19(1):50-52.DOI:10.3969/j.issn.1009-6604.2019.01.014.
[13] Catania VD,Lauriti G,Pierro A,et al.Open versus laparoscopic approach for intestinal malrotation in infants and children:a systematic review and meta-analysis[J].Pediatr Surg Int,2016,32(12):1157-1164.DOI:10.1007/s00383-016-3974-2.
[14] Son TN,Kien HH.Laparoscopic versus open surgery in management of congenital duodenal obstruction in neonates:a single-center experience with 112 cases[J].J Pediatr Surg,2017,52(12):1949-1951.DOI:10.1016/j.jpedsurg.2017.08.064.
[15] 张茜,汤绍涛,曹国庆,等.da Vinci机器人辅助腹腔镜Soave拖出术治疗先天性巨结肠症[J].中国微创外科杂志,2016,16(2):165-167,184.DOI:10.3969/j.issn.1009-6604.2016.02.019. Zhang Q,Tang ST,Cao GQ,et al.Robotic-assisted Da Vinci robot-assisted Soave pull-through for Hirschsprung’s disease in infants[J].Chin J Minim Inva Surg,2016,16(2):165-167,184.DOI:10.3969/j.issn.1009-6604.2016.02.019.
相似文献/References:
[1]陈永卫,侯大为,郭卫红,等.B超在新生儿十二指肠梗阻诊断中的应用[J].临床小儿外科杂志,2008,7(05):1.
[2]肖尚杰,杨文熠,朱小春,等. 腹腔镜治疗54例新生儿先天性十二指肠梗阻的疗效分析[J].临床小儿外科杂志,2019,18(02):141.
Xiao SJ,Yang WY,Zhu XC,et al. Analysis of laparoscopic diagnosis and treatment for 54 neonates with congenital duodenal obstruction.[J].Journal of Clinical Pediatric Surgery,2019,18(09):141.
[3]张书豪,高志刚,钭金法,等.机器人手术在小儿外科领域的应用现状[J].临床小儿外科杂志,2021,20(08):701.[doi:10.12260/lcxewkzz.2021.08.001]
Zhang Shuhao,Gao Zhigang,Tou Jinfa,et al.Current applications of robotic procedures in pediatric surgery[J].Journal of Clinical Pediatric Surgery,2021,20(09):701.[doi:10.12260/lcxewkzz.2021.08.001]
[4]谭征,俞建根,梁靓,等.机器人辅助胸腔镜技术治疗小儿先天性肺部疾病的单中心研究[J].临床小儿外科杂志,2021,20(08):708.[doi:10.12260/lcxewkzz.2021.08.002]
Tan Zheng,Yu Jiangeng,Liang Liang,et al.Robot-assisted thoracoscopy in the treatment of congenital pulmonary diseases in children[J].Journal of Clinical Pediatric Surgery,2021,20(09):708.[doi:10.12260/lcxewkzz.2021.08.002]
[5]赵扬,周辉霞,马立飞,等.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[J].临床小儿外科杂志,2021,20(08):712.[doi:10.12260/lcxewkzz.2021.08.003]
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(09):712.[doi:10.12260/lcxewkzz.2021.08.003]
[6]章跃滨,陈青江,蔡多特,等.机器人手术系统辅助儿童脾切除术三例并文献复习[J].临床小儿外科杂志,2021,20(08):718.[doi:10.12260/lcxewkzz.2021.08.004]
Zhang Yuebin,Chen Qingjiang,Cai Duote,et al.Robot-assisted laparoscopic splenectomy in children: a report of 3 cases with review of the literature[J].Journal of Clinical Pediatric Surgery,2021,20(09):718.[doi:10.12260/lcxewkzz.2021.08.004]
[7]马洪,汤显能,郭跃明.机器人手术系统辅助经皮原位固定术治疗儿童股骨头骨骺滑脱的比较研究[J].临床小儿外科杂志,2021,20(08):724.[doi:10.12260/lcxewkzz.2021.08.005]
Ma Hong,Tang Xianneng,Guo Yueming.Comparative study of percutaneous in stu fixation of slipped capital femoral epiphysis assisted by surgical robotic system[J].Journal of Clinical Pediatric Surgery,2021,20(09):724.[doi:10.12260/lcxewkzz.2021.08.005]
[8]陈艳,周立军,汪亚平,等.机器人辅助腹腔镜技术治疗儿童肾上腺嗜铬细胞瘤一例并文献复习[J].临床小儿外科杂志,2021,20(08):731.[doi:10.12260/lcxewkzz.2021.08.006]
Chen Yan,Zhou Lijun,Wang Yaping,et al.Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2021,20(09):731.[doi:10.12260/lcxewkzz.2021.08.006]
[9]胡家祥,聂梅兰,杨嘉飞,等.儿童上尿路结石的外科治疗进展[J].临床小儿外科杂志,2021,20(10):985.[doi:10.12260/lcxewkzz.2021.10.017]
Hu Jiaxiang,Nie Meilan,Yang Jiafei,et al.Recent advances in surgical treatment of upper urinary calculi in children[J].Journal of Clinical Pediatric Surgery,2021,20(09):985.[doi:10.12260/lcxewkzz.2021.10.017]
[10]朱炜玮,周辉霞,李品,等.机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗原发性膀胱输尿管反流的疗效对比[J].临床小儿外科杂志,2022,21(05):437.[doi:10.3760/cma.j.cn101785-202109034-008]
Zhu Weiwei,Zhou huixia,Li Pin,et al.Comparison of clinical efficacy of robot-assisted laparoscopic Lich-Gregoir procedure and gas-bladder laparoscopic Cohen ureteral reimplantation for primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2022,21(09):437.[doi:10.3760/cma.j.cn101785-202109034-008]
备注/Memo
收稿日期:2022-3-1。
基金项目:浙江省基础公益研究计划项目(LY22H040006)
通讯作者:钭金法,Email:toujinfa@zju.edu.cn