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目的:总结达芬奇辅助腹腔镜下小儿肾盂输尿管成形术的麻醉经验,探讨达芬奇机器人在小儿泌尿外科手术中的优越性及麻醉管理的复杂性。方法:回顾性分析2015年12月~2016年3月接受达芬奇辅助腹腔镜肾盂输尿管成形术20例(男12例,女8例,平均年龄6.4岁)患儿的麻醉过程及临床资料,术中监测呼气末二氧化碳分压和动脉血气,术后进行疼痛评估并记录麻醉时间、手术时间及住院时间,并与前期开腹手术治疗的22例患儿手术及麻醉过程进行比较。结果:20例患儿麻醉时间为(190.3±24.6)min,手术时间为(162.7±12.5)min,较开腹麻醉和手术时间明显延长;达芬奇辅助腹腔镜手术时,动脉血二氧化碳分压和呼气末二氧化碳分压在气腹开始后即明显高于气腹前的基线水平(P<0.05),pH在气腹开始1h后较气腹前明显降低(P<0.05);术中出血量(136.5±14.3)ml,术后疼痛评分(3.8±1.3),住院时间(5.6±1.0)d,均明显低于传统开腹手术。结论:达芬奇机器人手术在小儿泌尿外科治疗中具有创伤小、出血少、术野清晰、术后疼痛减轻等优点。但因气腹时间较长,较开腹手术相比,术中更易发生酸碱失衡,对麻醉管理要求更高。
OBJECTIVE: To summarize the experience of anesthesia assisted by da Vinci assisted by laparoscopic pediatric ureteropelvic angioplasty and to explore the superiority of da Vinci robot in pediatric urological surgery and the complexity of anesthesia management. Methods: A retrospective analysis was performed on the anesthesia and clinical data of 20 children (12 males and 8 females, mean age 6.4 years) receiving da Vinci assisted laparoscopic ureteropelvic polyposis between December 2015 and March 2016 During the operation, end-tidal carbon dioxide partial pressure and arterial blood gas were monitored. Postoperative pain assessment and anesthesia time, operation time and hospital stay were recorded. Surgical and anesthetic procedures were compared with those of 22 patients undergoing open surgery. Results: The duration of anesthesia was (190.3 ± 24.6) min and the duration of operation was (162.7 ± 12.5) min in 20 patients, which was significantly longer than that of open anesthesia and operation. In the laparoscopic da Vinci assisted laparoscopic surgery, arterial partial pressure of carbon dioxide And end-tidal carbon dioxide partial pressure were significantly higher than those before pneumoperitoneum (P <0.05). The pH was significantly lower than that before pneumoperitoneum (P <0.05) 1 h after pneumoperitoneum began. The intraoperative bleeding (136.5 ± 14.3) ml, postoperative pain score (3.8 ± 1.3) and hospital stay (5.6 ± 1.0) d were significantly lower than the traditional open surgery. Conclusion: Da Vinci robotic surgery in pediatric urological treatment with less trauma, less bleeding, clear operative field, postoperative pain relief and so on. However, due to longer pneumoperitoneum, compared with laparotomy, intraoperative more prone to acid-base imbalance, higher requirements for anesthesia management.