达芬奇机器人辅助下双镜联合治疗胆管结石的疗效分析

Efficacy Analysis of the Da Vinci Robotic-Assisted Dual Endoscopy Approach for the Treatment of Choledocholithiasis

摘要: 目的：评估达芬奇机器人辅助下双镜联合治疗胆管结石的疗效及临床应用价值。方法：回顾性分析2022年1月至2023年12月在济宁市第一人民医院收治46列胆管结石患者的临床资料，其中试验组11例接受达芬奇机器人辅助下腹腔镜胆囊切除加胆道镜探查取石联合治疗，对照组35例接受单纯腹腔镜胆囊切除加胆道镜探查联合治疗，两组均采用一期缝合胆管治疗方式；采用视觉模拟评分法(VAS)评估疼痛程度，术后1天和3天检测肝功能及血清中炎症指标。结果：两组结石清除率均为100.0%，试验组术中出血量、术后3 d VAS评分及术后3天腹腔引流量分别为：(6.6 ± 2.4) ml、(0.2 ± 0.6)分和(18.6 ± 15.9) ml，显著短于或少于对照组[分别为(13.5 ± 8.1) ml、(1.5 ± 0.5)分和(34.2 ± 20.9) ml，P < 0.05]；但试验组手术时长为(112.0 ± 19.2) min长于对照组(81.5 ± 20.4) min。两组术后肝功能、住院时间及血清炎症指标(CRP、WBC计数)无明显差异(P > 0.05)，但试验组术后1天和3天的血清PCT分别为(4.8 ± 9.0) ng/ml (1.1 ± 1.6) ng/ml均显著高于对照组[分别为(0.5 ± 0.9) ng/ml (0.2 ± 0.2) ng/ml，P < 0.05]。术后两组并发症无显著差异(P > 0.05)。结论：达芬奇机器人手术治疗胆管结石效果佳，减少出血、疼痛，有助于临床推广应用。

Abstract: Objective: To evaluate the efficacy and clinical value of the Da Vinci robotic-assisted dual-endoscope combined treatment for choledocholithiasis. Methods: A retrospective analysis was conducted on the clinical data of 46 patients with bile duct stones treated at Jining First People’s Hospital between January 2022 and December 2023. Among them, 11 patients in the experimental group underwent Da Vinci robot-assisted laparoscopic cholecystectomy combined with choledochoscopy for stone extraction, while 35 patients in the control group received conventional laparoscopic cholecystectomy combined with choledochoscopy. Both groups underwent primary closure of the bile duct. Pain levels were assessed using the Visual Analog Scale (VAS), and liver function as well as serum inflammatory markers were measured on postoperative days 1 and 3. Results: Both groups had a stone clearance rate of 100.0%. Intraoperative blood loss, postoperative day 3 VAS scores, and the amount of abdominal drainage on the third day post-surgery for the observation group were 6.6 ± 2.4 ml, 0.2 ± 0.6, and 18.6 ± 15.9 ml, respectively, which were significantly less than the control group, with 13.5 ± 8.1 ml, 1.5 ± 0.5, and 34.2 ± 20.9 ml (P < 0.05). However, the surgery duration for the observation group (112.0 ± 19.2 minutes) was longer than the control group (81.5 ± 20.4 minutes). There were no significant differences in postoperative liver function, length of hospital stay, or serum inflammatory markers (CRP, WBC count) between the two groups (P > 0.05). Nonetheless, serum PCT levels on the first and third days post-surgery for the observation group (4.8 ± 9.0 ng/ml, 1.1 ± 1.6 ng/ml) were significantly higher than those of the control group (0.5 ± 0.9 ng/ml, 0.2 ± 0.2 ng/ml, P < 0.05). There were no significant differences in complications between the two groups (P > 0.05). Conclusion: The da Vinci robotic surgery for treating gallstones shows excellent results, reducing bleeding and pain, which is conducive to its clinical promotion and application.