微创医学

目的探讨机器人辅助腹腔镜手术治疗小儿腹膜后肿瘤（RT）的可行性和安全性。方法回顾性分析2017年4月至2024年4月广西医科大学第一附属医院小儿外科采用机器人辅助腹腔镜手术治疗的12例RT患儿的临床资料。患儿术前均经腹部彩超、CT等检查明确肿瘤部位及其与周围组织的毗邻关系，其中男6例，女6例；年龄（月龄）2个月至14岁，中位年龄8.5岁；体重5.4～47.0 kg，中位体重25.5 kg；肿瘤直径2.5～14.0 cm，中位肿瘤直径4.2 cm。收集12例患儿手术时间、术中出血量及治疗结局等情况进行分析。结果 12例机器人辅助腹腔镜腹膜后肿瘤切除术（RRTR）均顺利完成，无中转手术病例。手术时间132～305（195.5±43.92）min；术中出血量0～100 mL，中位术中出血量20 mL，无术中及术后输血病例；术后进食时间1～5 d，中位术后进食时间2 d；术后使用止痛药频次0～7次，中位频次1次；术后住院时长4～14（7.17±1.75）d；4例（33.3%）恶性肿瘤患儿同时行肿瘤周围淋巴结清扫，术后病理检查显示肿瘤切缘均为阴性；术后1例（8.3%）患儿出现腹腔乳糜漏，经保守治疗治愈出院。术后随访8～48（17.00±8.33）个月，无肿瘤复发和再手术病例。结论 RRTR治疗小儿RT安全、可行，尤其在精细解剖和快速康复方面优势明显，为小儿RT的手术治疗提供了新选择。

Objective To investigate the feasibility and safety of robot-assisted laparoscopic surgery for retroperitoneal tumors (RT) in children. Methods A retrospective analysis was carried out on the clinical data of 12 RT children who underwent robot-assisted laparoscopic surgery in the department of pediatric surgery of the First Affiliated Hospital of Guangxi Medical University from April 2017 to April 2024. Preoperatively, all children underwent abdominal color ultrasound, CT and other examinations to clarify the location of the tumor and its adjacency with the surrounding tissues. Among them, there were 6 boys and 6 girls; the age (in months) ranged from 2 months to 14 years, with a median age of 8.5 years; the weight range was 5.4 to 47.0 kg, with a median weight of 25.5 kg; the tumor diameter range was 2.5 to 14.0 cm, with a median tumor diameter of 4.2 cm. The operation time, intraoperative blood loss, treatment outcomes, and other relevant data of the 12 children were collected for analysis. Results All 12 cases of roboti-assisted laparoscopic retroperitoneal tumor resection (RRTR) were successfully completed without converted surgery. The operation time was 132-305 (195.5±43.92) min, the intraoperative blood loss range was 0 to 100 mL, with a median of 20 mL, and no cases required intraoperative or postoperative blood transfusion. The postoperative feeding time range was 1 to 5 days, with a median of 2 days. The frequency range of postoperative use of analgesic drugs was 0 to 7 times, with a median of 1 time. The postoperative hospital stay was 4-14 (7.17±1.75) d. Four cases (33.33%) with malignant tumors underwent simultaneous peritumoral lymph node dissection, and postoperative pathological examination showed negative tumor margins in all cases. One case (8.3%) of the children presented with postoperative chylous leakage in the abdominal cavity and was conservatively cured and discharged. The postoperative follow-up period was 8-48 (17.00±8.33) months, with no tumor recurrence or reoperation cases. Conclusion RRTR is safe and feasible for the treatment of pediatric RT, particularly demonstrating significant advantages in meticulous anatomical dissection and enhanced recovery after surgery, providing a new option for the surgical treatment of pediatric RT.