中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

达芬奇机器人在纵隔肿瘤手术治疗中的临床疗效

查看全文

目的 比较达芬奇机器人与电视胸腔镜行纵隔肿瘤切除在围手术期的临床疗效。 方法 回顾性分析我院 2016 年 1 月自安装达芬奇机器人手术系统至 2017 年 10 月共 49 例纵隔肿瘤患者的临床资料,根据患者自身经济条件自愿选择手术方式,其中有 25 例患者选择机器人手术,男 14 例、女 11 例,年龄(56.5±17.9)岁;另外 24 例患者选择电视胸腔镜手术组,男 15 例、女 9 例,年龄(53.0±17.8)岁。 结果 达芬奇机器人组和电视胸腔镜组手术时间差异无统计学意义(t=–0.365,P=0.681)。达芬奇机器人组术中出血量(t=–2.569,P=0.002),术后 3 d 引流量(t=–6.325,P=0.045),术后引流管拔管时间更短(t=–1.687,P=0.024)和术后住院时间更短(t=–3.689,P=0.021),术后 48 h 视觉模拟评分(VAS)更低(t=–7.214,P=0.014)。 结论 达芬奇机器人行纵隔肿瘤切除术是安全的,其手术时间与电视胸腔镜无较大差别,但在术后恢复方面,达芬奇较电视胸腔镜有明显优势。

Objective To summarize the clinical data about mediastinal lesions, then to analyze the treatment effect of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods We retrospectively analyzed the clinical data of 49 patients with mediastinal lesions in our hospital between January 2016 and October 2017. These patients were divided into two groups including a da Vinci robot group and a video-assisted thoracoscopic surgery (VATS) group according to the selection of the treatments. There were 25 patients with 14 males and 11 females at age of 56.5±17.9 years in the da Vinci group and 24 patient with 15 males and 14 females at age of 53.0±17.8 years. Results There was no statistical difference in surgery time between two groups (t=–0.365, P=0.681). Less intraoperative blood loss (t=–2.569, P=0.002), less postoperative drainage amount within three days after surgery (t=–6.325, P=0.045), shorter period of bearing drainage tubes after surgery (t=–1.687, P=0.024), shorter hospital stays (t=–3.689, P=0.021), lower visual analogue scale(VAS) scores of postoperative 48 hours b(t=–7.214, P=0.014) with a statistical difference in the da Vinci robot group compared with the VATS group. Conclusion The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach.

关键词: 纵隔肿瘤; 达芬奇机器人手术系统; 电视胸腔镜; 术后恢复

Key words: Da Vinci robot system; mediastinal lesions; minimally invasive surgery

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Buentzel J, Straube C, Heinz J, et al. Thymectomy via open surgery or robotic video assisted thoracic surgery: Can a recommendation already be made?. Medicine (Baltimore), 2017, 96(24): e7161.
2. Friedant A J, Handorf E A, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol., 2016, 11(1): 30-38.
3. 杨胜利, 茹婷巧, 杨劼,等. 单操作孔全电视胸腔镜手术在纵隔肿物切除中的应用. 华中科技大学学报(医学版), 2015, 44(3): 330-333.
4. 陈世雄, 陈胜家, 许家君, 等. 单操作孔电视胸腔镜手术治疗前纵隔肿瘤. 中国胸心血管外科临床杂志, 2016, 23(1): 634-635.
5. Bodner J, Wykypiel H, Wetscher G, et al. First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg, 2004, 25(5): 844-851.
6. Bodner J, Wykypiel H, Greiner A, et al. Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg, 2004, 78(1): 259-265.
7. Augustin F, Schmid T, Bodner J. The robotic approach for mediastinal lesions. Int J Med Robot, 2006, 2(3): 262-270.
8. Marulli G, Schiavon M, Perissinotto E, et al. Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis. J Thorac Cardiovasc Surg, 2013, 145(3): 730-736.
9. Marulli G, Comacchio G M, Rea F. Robotic thymectomy. Journal of visualized surgery, 2017, 3(1): 68.
10. Marulli G, Maessen J, Melfi F, et al. Multi-institutional European experience of robotic thymectomy for thymoma. Annals of cardiothoracic surgery, 2016, 5(1): 18-25.
11. Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
12. Hartwich J, Tyagi S, Margaron F, et al. Robot-assisted thoracoscopic thymectomy for treating myasthenia gravis in children. J Laparoendosc Adv Surg Tech A, 2012, 22(9): 925-929.
13. 丁仁泉, 童向东, 许世广, 等. 达芬奇机器人手术系统与电视电视胸腔镜在胸内纵隔疾病手术治疗中的对比研究. 中国肺癌杂志, 2014, 7(1): 557-562.
14. Ruckert J C, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg, 2011, 141(3): 673-677.
15. Castle S L, Kernstine K H. Robotic-assisted thymectomy. Semin Thorac Cardiovasc Surg, 2008, 20(4): 326-331.
16. Nakamura H, Suda T, Ikeda N, et al. Initial results of robot-assisted thoracoscopic surgery in Japan. Gen Thorac Cardiovasc Surg, 2014, 62(12): 720-725.
17. Jun Y, Hao L, Demin L, et al. Da Vinci robot-assisted system for thymectomy: experience of 55 patients in China. Int J Med Robot, 2014, 10(3): 294-299.
18. 刘博, 汪明敏, 许世广, 等. 达芬奇机器人纵隔肿瘤切除术的学习曲线. 中国胸心血管外科临床杂志, 2017, 2(1): 127-131.
19. Rueckert J, Swierzy M, Badakhshi H, et al. Robotic-assisted thymectomy: surgical procedure and results. The Thoracic and cardiovascular surgeon, 2015, 63(3): 194-200.
20. Ye B, Tantai J C, Li W, et al. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stage I thymoma. World J Surg Oncol, 2013, 11(1):157.
21. Della Marina A, Kolbel H, Mullers M, et al. Outcome after robotic-assisted thymectomy in children and adolescents with acetylcholine receptor antibody-positive juvenile myasthenia gravis. Neuropediatrics, 2017, 48(4): 315-322.
22. Straughan DM, Fontaine JP, Toloza EM. Robotic-assisted videothoracoscopic mediastinal surgery. Cancer Control, 2015, 22(3): 326-330.