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机器人与传统腹腔镜在小儿胆总管囊肿手术中应用 的对比研究

关键词： 胆总管囊肿；机器人辅助手术；腹腔镜手术；并发症；肝管空肠吻合术

池水清，徐银慧，汤绍涛，张茜，曹国庆，李帅   

  • Vol. 2 No. 4 Aug. 2021
  • DIO:10.12180/j.issn.2096-7721.2021.04.002 发布日期:2022-01-21 阅读数:356
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  • 作者简介:

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目的：对比分析机器人和传统腹腔镜手术在胆总管囊肿切除、肝管空肠吻合术中的应用效果。方法：回顾性分析 2014 年 6 月 ~2021 年 2 月行机器人或传统腹腔镜辅助下胆总管囊肿切除 + 肝管空肠吻合术患儿（170 例）的病例资料，分析两组患儿手术情况、术中及术后并发症的发生率，并建立多因素Logistic 回归模型，以寻找胆总管囊肿术后出现并发症的危险因素。结果：与传统腹腔镜手术比较，机器人手术患儿的总手术时间更长，囊肿切除和肝管空肠吻合时间更短，术中解剖结构（左、右肝管开口及胰内胆管）显示更清晰，术中失血量较少，平均住院时间更短，术后早期并发症发生率较低。多因素 Logistic 回归分析显示，肝管空肠吻合的时间延长是胆总管囊肿术后出现并发症的唯一危险因素。结论：机器人辅助胆总管囊肿手术解剖更清晰，术中和术后并发症少，短期的预后更好。

Objective: To study the differences of intraoperative and postoperative outcomes on choledochal cyst (CC) excision and hepaticojejunostomy between robotic and laparoscopic approaches. Methods: A retrospective case-control study  of 170 patients underwent robot assisted and traditional laparoscopic CC excision and hepaticojejunostomy was performed at the Wuhan Union Hospital from Jun 2014 to Feb 2021. A multivariable logistic regression model for odds to complications was built. Results: Patients underwent robot-assisted hepaticojejunostomy (RAS) had a longer overall operative time, shorter cyst excision time, shorter hepaticojejunostomy time, less estimated blood loss, lower postoperative high fever rate, shorter postoperative LOS, and a lower postoperative complication rate. Moreover, the intraoperative anatomic structures were more explicit in group of RAS, such as the exposure of left or right hepatic duct opening and intrapancreatic bile duct. Multivariable logistic regression showed that longer hepaticojejunostomy time was the only risk factor of postoperative complications. Conclusion: Robot-assisted CC excision and hepaticojejunostomy is associated with better intraoperative view, less intraoperative and postoperative complications and better short-term postoperative outcomes compared to laparoscopic approach.