[1]蒋彬,康珀铭,陶绍霖,等.机器人与胸腔镜手术治疗前纵隔肿物的近期疗效对比[J].第三军医大学学报,2019,41(16):1578-1582.
 JIANG Bin,KANG Poming,TAO Shaolin,et al.Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass[J].J Third Mil Med Univ,2019,41(16):1578-1582.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第16期
页码:
1578-1582
栏目:
临床医学
出版日期:
2019-08-30

文章信息/Info

Title:
Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass
作者:
蒋彬康珀铭陶绍霖沈诚邓波王如文谭群友
陆军军医大学(第三军医大学)大坪医院全军胸外科研究所
Author(s):
JIANG Bin KANG Poming TAO Shaolin SHEN Cheng DENG Bo WANG Ruwen TAN Qunyou 

Institute of Thoracic Surgery, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China

关键词:
前纵隔肿物机器人手术电视胸腔镜手术微创胸外科
Keywords:
anterior mediastinal mass robot-assisted surgery video-assisted thoracoscopic surgery minimally invasive thoracic surgery
分类号:
R181.32;R616;R655.5
文献标志码:
A
摘要:

目的 比较机器人与胸腔镜手术治疗前纵隔肿物的近期临床疗效,探讨机器人辅助前纵隔肿物切除的优势。方法 采用回顾性队列研究的方法,收集2016年10月至2018年9月陆军军医大学(第三军医大学)大坪医院收治的111例行微创前纵隔肿物切除手术患者的临床病理资料。111例患者中,56例行达芬奇机器人手术,设为机器人组;55例行电视胸腔镜手术,设为胸腔镜组。对两组患者的病变直径、直径≥5 cm例数、手术时间、术中失血量、中转开胸率、术后引流量、术后胸引天数、联合扩大切除例数、术后住院日、并发症发生率和住院费用进行比较分析。结果全组患者均顺利完成手术,无围术期死亡。机器人组对比胸腔镜组,在病变直径[(4.6±2.2) vs (3.3±1.6)cm,P=0.002]、直径≥5 cm比例(22/56 vs 11/55,P=0.026)、术中失血量[(54.1±51.6) vs (89.9±91.0) mL,P=0.013]、联合扩大切除率(8/56 vs 1/55,P=0.04)、住院费用[(7.5±2.0) vs (4.2±1.4)万元,P<0.001]方面差异有统计学意义;两组在手术时间、中转开胸率、术后引流量、术后胸引天数、术后住院日、并发症发生率上差异均无统计学意义(P>0.05)。结论 机器人辅助前纵隔肿物切除术安全可行,但费用较高;与胸腔镜手术比较出血更少,在大血管周围和深部狭小空间内操作有一定优势,对直径较大或有明显外侵需联合大血管切除的前纵隔肿瘤更为适用。

Abstract:

Objective To compare the short-term clinical efficacy of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for anterior mediastinal mass and investigate the advantages of robot-assisted surgery. MethodsThis retrospective cohort study was conducted in 111 patients undergoing minimally invasive surgery for anterior mediastinal mass in Daping Hospital of Army Medical University between October, 2016 and September, 2017. Of the 111 patients, 56 underwent Da Vinci robotic surgery (RATS group) and 55 underwent VATS. The clinicopathological data were collected from the two groups for comparison of the tumor diameter, number of cases with tumor diameter ≥5 cm, operation time, intraoperative blood loss, conversion to open surgery rate, postoperative pleural drainage volume, days of pleural drainage, extended resection rate, postoperative hospital stay, complications and hospitalization costs. ResultsThe operations were completed successfully in all the patients without perioperative mortality. Compared with those in VATS group, the patients with RATS had significantly larger tumor diameter (4.6±2.2 vs 3.3±1.6 cm, P=0.002), more cases with a tumor diameter ≥5 cm (22/56 vs 11/55, P=0.026), a less intraoperative blood loss volume (54.1±51.6 vs 89.9±91.0 mL, P=0.013), and a higher rate of extended resection (8/56 vs 1/54, P=0.040). The hospitalization costs in RATS group was much higher than that in VATS group (P<0.001). No significant differences were found between the two groups in the operation time, conversion to open surgery rate, postoperative pleural drainage volume, days of pleural drainage, postoperative hospital stay or incidence of complications. ConclusionRATS is safe and feasible for treatment of anterior mediastinal mass, but its hospitalization costs are much higher. Compared with VATS, RATS is associated with less intraoperative blood loss and allows more convenient operations around large vessels and in deep and narrow space. RATS is more suitable for anterior mediastinal tumors with a larger diameter or with external invasion, which requires extended resection along with the large vessels.

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更新日期/Last Update: 2019-08-22