背景:良性胆道疾病(BBD)是一种常见的疾病,涉及由于非恶性原因需要肝外胆管切除和重建的患者。
方法:这项研究追踪了2015年至2023年接受BBD胆道切除术的所有患者。我们排除了患有恶性疾病的患者和进行“开放”手术的患者。根据病人的解剖结构,采用的程序是机器人Roux-en-Y肝空肠吻合术(RYHJ)或机器人胆总管十二指肠吻合术(CDD)。
结果:从研究的33名患者中,23是女性,10个是男性。麻醉学(ASA)等级为3±0.5;MELD评分为9±4.1;Child-Pugh评分为6±1.7。接受手术的主要适应症包括医源性胆管损伤,胆道狭窄,和1型胆总管囊肿。平均手术时间约为272分钟,平均失血量为79mL。术后,三名患者经历了重大并发症,都是吻合口泄漏造成的.平均住院时间为4天,30天内再入院率为15%。平均随访33个月,1例患者由于狭窄在18个月时不得不进行翻修.这需要进一步的导管切除和再吻合。值得注意的是,没有肝切除术的报道,没有转换到\'open\'方法,术中无并发症,没有死亡。
结论:机器人肝外胆管切除和重建与Roux-en-Y肝空肠吻合术或胆总管十二指肠吻合术是安全的,术后发病率可接受。住院时间短,中期随访,术后狭窄率低。
Benign biliary disease (BBD) is a prevalent condition involving patients who require extrahepatic bile duct resections and reconstructions due to nonmalignant causes.
This study followed all patients who underwent biliary resections for BBD between 2015 and 2023. We excluded those with malignant conditions and patients who had an \'open\' operation. Based on the patient\'s anatomy, the procedures employed were either robotic Roux-en-Y hepaticojejunostomy (RYHJ) or robotic choledochoduodenostomy (CDD).
From the 33 patients studied, 23 were female, and 10 were male. Anesthesiology (ASA) class was 3 ± 0.5; the MELD score was 9 ± 4.1; the Child-Pugh score was 6 ± 1.7. The primary indications for undergoing the operation included iatrogenic bile duct injuries, biliary strictures, and type 1 choledochal cysts. The average surgical duration was about 272 min, and the average blood loss amounted to 79 mL. Postoperatively, three patients experienced major complications, all attributed to anastomotic leaks. The average hospital stay was 4 days, with a readmission rate of 15% within 30 days. During an average follow-up period of 33 months, one patient had to undergo a revision at 18 months due to stricture. This necessitated further duct resection and reanastomosis. Notably, there were no reported hepatectomies, no conversion to the \'open\' method, no intraoperative complications, and no mortalities.
Robotic extrahepatic bile duct resection and reconstruction with Roux-en-Y hepaticojejunostomy or choledochoduodenostomy is safe with an acceptable postoperative morbidity, short hospital length of stay, and low postoperative stricture rate at intermediate duration follow-up.