中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

早期肺癌患者行达芬奇机器人与胸腔镜肺癌根治术的病例对照研究

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目的 对机器人辅助胸腔镜下肺癌根治术(robot-assisted thoracic surgery,RATS)和胸腔镜下肺癌根治术(video-assisted thoracic surgery,VATS)治疗早期肺癌患者的疗效进行客观评价。 方法 回顾性分析 2016 年 1 月至 2017 年 12 月甘肃省人民医院 80 例行肺癌根治术患者的临床数据资料,其中男 51 例、女 29 例。VATS 组 43 例,RATS 组 37 例,用 Stata v14.0 统计软件进行数据处理。 结果 RATS 组手术时间明显较 VATS 组长(172.21 min vs. 162.20 min,P=0.018)。RATS 组手术费用比 VATS 组高(74 076.69 元 vs. 54 814.73 元,P<0.001)。RATS 组术后住院时间比 VATS 组短(8.27 dvs. 10.76 d,P=0.001)。两组术中中转开胸例数(3 例vs. 0 例,P=0.144)、术中失血量(61.29 ml vs. 90.63 ml,P=0.213)、淋巴结清扫总数量(17.38 vs. 12.63,P=0.095),术后引流量(1 406.76 ml vs.1 514.60 ml,P=0.617)以及术后引流管留置时间(7.92 d vs.7.20 d,P=0.440)差异无统计学意义。 结论 行肺癌根治手术的早期肺癌患者中,机器人组术后住院时间明显比胸腔镜组短,手术时间较胸腔镜组长,其余近期手术指标与胸腔镜类似,机器人手术没有明显优势;但机器人在淋巴结清扫难度较大、周围组织粘连严重、解剖关系异常复杂的患者的治疗上有较大的优势。

Objective To evaluate the curative effect of robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for early stage lung cancer patients. Methods We retrospectively analyzed the clinical data of 80 patients with radical resection of lung cancer in Gansu Provincial Hospital between January 2016 and December 2017. The patients were divided into two groups: 43 patients in a VATS group and 37 in a RATS group. There were 51 males and 29 females. Data were processed with STATA v14.0 statistical software. Results There were significant differences in the operative time, duration of hospital stay and operative costs between the two groups. In the RATS group, operative duration was longer (172.21 minutes versus 162.20 minutes, P=0.018), cost was higher (74 076.69 yuan versus 54 814.73 yuan, P<0.001), and required significantly shorter hospital stay (8.27 daysversus 10.76 days, P=0.001) compared with those of the VATS group. There was no statistical difference between the two groups in terms of conversion (3 versus 0, P=0.144), blood loss during operation (61.29 ml versus 90.63 ml, P=0.213), dissected lymph node number (17.38 versus 12.63, P=0.095), drainage volume (1 406.76 ml versus 1 514.60 ml, P=0.617) and the drainage time (7.92 days versus 7.20 days, P=0.440). Conclusion In the early lung cancer patients who underwent thoracic surgery, the postoperative hospitalization time of the RATS group is shorter than that of the VATS group, and the operation time is longer than that of the VATS group. The other short-term surgical indexes are similar to those of thoracoscopic surgery. However, the robot has great advantages in the treatment of patients with difficult lymph node dissection, serious pleural adhesion and complicated anatomical relationship.

关键词: 机器人; 胸腔镜手术;  肺癌;  微创

Key words: Robot; thoracoscopy; lung cancer; minimally invasive

引用本文: 马继龙, 金大成, 韩松辰, 陈猛, 苟云久. 早期肺癌患者行达芬奇机器人与胸腔镜肺癌根治术的病例对照研究. 中国胸心血管外科临床杂志, 2019, 26(1): 48-52. doi: 10.7507/1007-4848.201805002 复制

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