机器人外科手术系统辅助治疗纵隔肿瘤的初步经验

Initial experiences with robot-assisted surgery in treatment of mediastinal tumor

目的评估达芬奇S机器人外科手术系统对普胸外科纵隔肿瘤手术的适用性,为纵隔肿瘤的切除提供新的思路和外科手术方法。方法 2009年5月-2010年7月上海交通大学附属胸科医院共有6例患者应用达芬奇S机器人外科手术系统施行纵隔肿瘤切除术,于全身麻醉下行气管双腔管插管,右侧抬高45°,分别作光源孔和手臂操作孔。观察患者术后并发症及住院时间等临床指标。结果 6例达芬奇S机器人外科手术系统辅助纵隔肿瘤切除手术均成功,无1例中转开胸。术后病理检查提示,胸腺瘤3例,胸腺囊肿1例,胸腺增生1例,神经鞘瘤1例。中位手术时间为118min,术中中位失血量为48.3 mL,中位住院天数为4.6d,无1例发生术后并发症。术后3例胸腺瘤患者随访无1例复发。结论达芬奇S机器人外科手术系统辅助纵隔肿瘤切除术安全、可靠,手术视野的暴露完全能够达到开胸手术的要求,且可达到与开胸手术同样的效果。

Objective To evaluate the applicability of the da robot-assisted surgery for medistinal tumor surgery,so as to provide new ways for resection of medistinal tumors.Methods From May 2009 to Jul.2010,a total of 6 patients received mediastinal tumor surgery using the da Vincie robot-assisted surgery.The double-lumen endobronchial tube intubation was done under general anesthesia.The complications and hospital stay of the patients were observed.Results The operation was successfully accomplished using da Vinci surgical robotic system in all the 6 patients,with no transfer to open chest operation.Postoperative pathological findings revealed 3 thymoma,one thymic cyst,one thymic hyperplasia,and one neurilemmoma.The operation time was 95- 142 min（mean,118 min） and the intraoperative blood loss was 20—100 mL（mean,48.3 mL）.The mean hospital stay was 4.6 days.No blood transfusion was required and there were no postoperative complications.Conclusion The da Vincie operation robot is safe and reliable for mediastinal tumor resection;the exposed operation field can meet the requirement for open chest hospital and can achieve the same result as in the open chest operation.