中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

79 例完全无管化机器人纵隔肿物切除术的回顾性分析研究

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目的 分析达芬奇机器人纵隔肿物切除手术完全无管化(totally no tube,TNT)的可行性及其对加速康复外科的重要意义。 方法 纳入 2016 年 1 月至 2017 年 12 月期间在沈阳军区总医院行 TNT 机器人纵隔肿物切除手术的患者 79 例,作为 TNT 组;纳入 2014 年 1 月至 2017 年 12 月期间在沈阳军区总医院行普通机器人纵隔肿物切除手术的患者 35 例,同期行胸腔镜纵隔肿物切除手术的患者 54 例,分别作为非 TNT 组和电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)组。回顾性分析三组患者的肌肉松弛-气管插管/喉罩时间、手术时间、术中出血量、术后重症监护时间、术后住院时间、术后疼痛视觉模拟评分(visual analogue scale,VAS)、住院费用及术后并发症等相关指标。 结果 168 例患者手术皆成功完成,无中转开胸、围手术期无严重并发症(共 9 例患者出现术后并发症)及死亡患者,所有患者顺利出院。TNT 组与非 TNT 组对比,肌肉松弛-气管插管/喉罩时间、手术时间、术中出血量、术后次日 VAS 疼痛评分、重症监护时间、术后住院时间方面 TNT 组均明显短于或少于非 TNT 组(P<0.01);两组住院总费用差异无统计学意义(P>0.05)。非 TNT 组与 VATS 组相比,肌肉松弛-气管插管时间、手术时间、重症监护时间差异无统计学意义(P>0.05);在术中出血量、术后次日 VAS 疼痛评分、术后连续 3 d 胸腔引流量、术后带管时间、术后住院时间方面非 TNT 组优于 VATS 组(P<0.05),但非 TNT 组住院费用明显较高(P=0.000)。 结论 达芬奇机器人用于治疗纵隔肿物与胸腔镜手术相比安全性相当,在机器人手术基础上行 TNT 也是安全可靠的,具有更好的舒适度、疼痛更轻,重症监护及住院时间更短等优势,患者能更快恢复。

Objective To analyze the feasibility of totally no tube (TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery (VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay, postoperative hospital stay, postoperative visual analogue scale (VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications (postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay (P<0.01); there was no significant difference in the total cost of hospitalization between the two groups (P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay (P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss, VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay (P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher (P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.

关键词: 达芬奇机器人; 电视胸腔镜; 完全无管化; 纵隔肿物

Key words: da Vinci robot; video-assisted thoracoscope; totally no tube; mediastinal tumor

引用本文: 孟祥瑞, 徐惟, 刘博, 王希龙, 代锋, 康云腾, 林杰, 刘星池, 许世广, 王述民. 79 例完全无管化机器人纵隔肿物切除术的回顾性分析研究. 中国胸心血管外科临床杂志, 2019, 26(3): 211-216. doi: 10.7507/1007-4848.201805076 复制

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