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机器人辅助与胸腔镜辅助胸外科手术在非小细胞肺癌中的疗效对比

Comparison of the efficacy of robot assisted and thoracoscopic assisted thoracic surgery in non-small cell lung cancer
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摘要 目的比较机器人辅助胸外科手术(RATS)及电视辅助胸腔镜外科手术(VATS)在非小细胞肺癌(NSCLC)治疗中的安全性及短期疗效。方法回顾性分析2021年1月至2022年12月于中南大学湘雅医院行RATS及VATS的2058例NSCLC患者的临床资料,其中男1006例,女1052例,年龄为(57.3±9.9)岁。根据手术方法分为RATS组(n=1190)及VATS组(n=868)。采用最近邻匹配法进行1∶1倾向性评分匹配(PSM)。比较PSM前后RATS组与VATS组患者的术中情况及术后并发症发生率等情况。并且PSM后根据手术方式的患者进行分层分析,分别比较肺叶切除和肺段切除的患者中VATS组和RATS组的术中情况及术后并发症发生率的差异。结果PSM后一共纳入1692例患者,其中VATS组与RATS组均为846例。根据手术方式分层后,肺叶切除患者中RATS组为503例,VATS组为548例,肺段切除患者中RATS组为338例,VATS组为298例。PSM前RATS组与VATS组在术中中转开胸、淋巴结清扫/采样站数、拔管时间、住院总时长及住院总费用方面差异均有统计学意义(均P<0.001)。PSM后与VATS组相比,RATS组手术中转开胸率更低[1.2%(10/846)比5.1%(43/846)]、术中出血量更少[(73.6±77.4)ml比(112.6±239.3)ml]、采样/清扫淋巴结站数更多[(4.8±2.0)比(3.7±1.8)]、引流管留置时间更短[(3.6±2.7)d比(4.1±2.5)d]、术后引流量更多[(273.9±183.0)ml比(256.5±168.7)ml](均P<0.001)。两组术后并发症发生率的差异无统计学意义(P=0.108)。手术分层分析结果显示,在肺叶手术及肺段手术中两组在术中出血量、淋巴结清扫/采样站数、拔管时间及住院总费用方面差异均有统计学意义(均P<0.001)。在肺叶切除手术中,RATS组中转开胸率低于VATS组[1.6%(8/503)比7.7%(42/548),P<0.001]。在肺段切除手术中,RATS组的术后引流量多于VATS组[(249.8±151.5)ml比(218.7±132.9)ml,P=0.023]。两组患者在肺叶切除术与肺段切除术中的手术并发症发生率差异无统计学意义(均P>0.05)。结论在NSCLC手术治疗中,RATS在降低患者中转开胸率、减少围手术期不良事件发生及促进患者术后快速康复方面较VATS更具有优势。 Objective To compare the safety and short-term efficacy of robotic-assisted thoracic surgery(RATS)and video-assisted thoracoscopic surgery(VATS)in patients with non-small cell lung cancer(NSCLC).Methods A retrospective analysis of the clinical data of 2058 NSCLC patients who underwent RATS and VATS from January 2021 to December 2022 in Xiangya Hospital of Central South University was conducted,including 1006 males and 1052 females,with the age of(57.3±9.9)years.According to the surgical approach,the patients were divided into RATS group(n=1190)and VATS group(n=868).The nearest neighbor matching method was used to perform 1∶1 propensity score matching(PSM).A comparison was made about the intraoperative conditions and postoperative complication rates between the RATS and VATS groups before and after PSM.Furthermore,after PSM,a stratified analysis was conducted based on surgical approach,separately comparing the intraoperative conditions and postoperative complication rates between the VATS and RATS groups among patients who underwent lobectomy and segmentectomy,respectively.Results After PSM,a total of 1692 patients were included,with 846 patients in both the VATS and RATS groups.After stratification based on surgical approach,there were 503 patients in the RATS group and 548 patients in the VATS group for lobectomy,and 338 patients in the RATS group and 298 patients in the VATS group for segmentectomy.Before PSM,statistically significant differences were observed between the RATS and VATS groups in terms of intraoperative conversion to open thoracotomy,number of lymph node dissection/sampling stations,extubation time,total length of hospital stay,and total hospitalization costs(all P<0.001).After PSM,compared with the VATS group,the RATS group had a lower intraoperative conversion rate to open surgery[1.2%(10/846)vs 5.1%(43/846)],less intraoperative blood loss[(73.6±77.4)ml vs(112.6±239.3)ml],a greater number of sampled/dissected lymph node stations[(4.8±2.0)vs(3.7±1.8)],a shorter duration of drainage tube placement[(3.6±2.7)d vs(4.1±2.5)d],and a higher postoperative drainage volume[(273.9±183.0)ml vs(256.5±168.7)ml](all P<0.001).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P=0.108).The results of the surgical stratification analysis showed statistically significant differences between the two groups in terms of intraoperative blood loss,number of lymph node dissection/sampling stations,extubation time,and total hospitalization costs for both lobectomy and segmentectomy surgeries(all P<0.001).In lobectomy surgeries,the RATS group had a lower rate of intraoperative conversion to open thoracotomy than that of VATS group[1.6%(8/503)vs 7.7%(42/548),P<0.001].In segmentectomy surgeries,the RATS group had more postoperative drainage volume than that of VATS group[(249.8±151.5)ml vs(218.7±132.9)ml,P=0.023].There was no statistically significant difference in the incidence of surgical complications between the two groups for both lobectomy and segmentectomy surgeries(both P>0.05).Conclusion In the surgical management of NSCLC,RATS offers more advantages over VATS in reducing conversion rates to open surgery,minimizing perioperative adverse events,and facilitating faster patient recovery postoperatively.
作者 周追求 周宇轩 曾俊 林航 程远大 张春芳 Zhou Zhuiqiu;Zhou Yuxuan;Zeng Jun;Lin Hang;Cheng Yuanda;Zhang Chunfang(Department of Thoracic Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis&Treatment,Changsha 410008,China)
出处 《中华医学杂志》 CAS CSCD 北大核心 2024年第34期3221-3227,共7页 National Medical Journal of China
基金 国家自然科学基金(82172655) 国家老年疾病临床研究中心项目(2021LNJJ17) 湖南省自然科学基金(2022JJ40773)
关键词 肺肿瘤 非小细胞肺癌 机器人辅助胸外科手术 电视镜辅助胸外科手术 倾向得分匹配 Lung neoplasms Non-small cell lung cancer Robotic assistant thoracic surgery Video-assisted thoracoscopic surgery Propensity score matching
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