机器人与胸腔镜手术治疗早期肺癌的疗效对比

Comparion about efficacy between Robot-assisted and thoracoscopic radical operation of early stage lung cancer

目的对比研究达芬奇机器人与胸腔镜进行早期肺癌根治手术的围手术期数据,评价达芬奇机器人在早期肺癌根治手术的临床价值。方法回顾性分析2020年6月-2022年1月在某院胸外科行达芬奇机器人肺癌根治术25例患者(机器人组)和胸腔镜下肺癌根治术47例患者(胸腔镜组)的临床资料。比较两组患者手术时间、术中失血量、清扫淋巴结组数及个数、胸腔引流管量以及术后并发症等指标,从而明确两种手术方式的有效性差异。结果机器人组比胸腔镜组术中出血量更少(90.89±22.33ml Vs 119.72±19.48ml,P=0.007),手术时间更长(178.53±51.78min Vs 132.64±48.24min,P=0.012),住院花费更多(7.48±1.25万元Vs 4.66±1.83万元,P<0.001)。胸腔镜组清扫的淋巴结数量更多(16.91±4.46 Vs 10.35±1.88,P<0.05),但在清扫阳性淋巴结数量及淋巴结术后病理升期方面两组无差异(P>0.05)。结论机器人手术系统在早期肺癌根治手术中,出血量少,住院时间短,淋巴结清扫优势大,术后疼痛感轻,操作安全有效且创伤小,可作为早期肺癌手术治疗的有效方法。

Objective To evaluate the clinical value of robot-assisted segmentectomy by comparing the perioperative data of early stage lung cancer patients who underwent with Davinci robot-assisted therapy or thoracoscopic radical operation for lung cancer.Methods Clinical data of 25 patients who underwent robot-assisted radical resection of lung cancer(RAST group)and 47 patients who underwent thoracoscopic radical resection of lung cancer(VAST group)at the department of thoracic surgery of People’s hospital of Xinjiang from June 2020 to January 2022 were retrospectively analyzed.The operative time,intraoperative blood loss,number and groups of lymph node dissection,total drainage volumeof chest drainage tube,and postoperative complications of the two groups were compared to determine the different clinical effectiveness of the two approaches.Results The RAST group showed less intraoperative blood loss compared with VAST group(90.89±22.33 mlvs 119.72±19.48ml,P=0.007),The total postoperative pain scores after surgery in VAST group was lower than that in VAST group(3.57±0.16 vs 5.45±0.81,P=0.038).The RAST group had a longer operative time(178.53±51.78 minvs 132.64±48.24 min,P=0.012),and moreexpenses(7.48±1.25 Million CNY vs 4.66±1.83 Million CNY,P<0.001)than those in VAST group.The RAST group dissect more lymph nodes than that in VAST group(16.91±4.46 vs 10.35±1.88,P<0.05),but the RAST group was the same amount of positive lymph node dissection and pathological stages upgrade of postoperative lymph node as the VAST group(P>0.05).Conclusion Robotic surgery systemhas the lowerintraoperative blood loss,the lighter postoperative pain,the shorter postoperative hospitalization and more lymph node dissection,it is safe and effective in the segmental resection forearly stage of lung cancer.