达芬奇机器人纵隔肿物切除术23例临床分析

Da Vinci Surgical System for Resection of Mediastinal Tumor:A Report of 23 Cases

目的探讨应用达芬奇机器人行纵隔肿物切除术的可行性。方法回顾性分析2009年1月～2012年12月通过达芬奇机器人行纵隔肿物切除手术23例的临床资料。年龄33～72岁,平均48.8岁。前纵隔肿物19例,中纵隔肿物1例,后纵隔肿物3例。三孔法,左侧机械臂为抓钳,右侧机械臂为超声刀,中间为观察孔。前纵隔胸腺来源肿物行全胸腺切除术,后纵隔及中纵隔来源肿物沿肿物包膜完整切除。结果 23例手术均获成功,全胸腺切除术19例,中纵隔气管囊肿剥除术1例,后纵隔肿物切除术3例。手术时间(93.9±38.6)min,术中出血(55.2±18.6)ml,术后24小时胸管引流量(115.2±69.9)ml,术后住院时间(5.4±1.4)d。全组无围手术期死亡,无中转开胸。术后病理示胸腺瘤16例,神经鞘瘤3例,胸腺囊肿2例,胸腺增生及支气管囊肿各1例。23例随访1～48个月,平均20个月,无复发。结论应用达芬奇机器人行纵隔肿物切除术安全可行。

Objective To investigate the feasibility of da Vinci surgical system in the treatment of mediastinal tumor Methods From January 2009 to December 2012, by using da Vinci surgical system, we performed resection of mediastinal tumor on totally 23 patients （mean age： 48. 8 years, ranged from 33 to 72 ）. Among the cases, the tumor was detected in the anterior mediastinum in 19 patients, middle mediastinum in 1, and posterior mediastinum in 3. Three ports were used, with the left mechanical arm for forceps, right mechanical arm for ultrasonic scalpel, and the middle hole for observation. Total thymectomy was performed on the patients with anterior mediastinal tumor, and resection of the middle or posterior mediastinal tumor was carried out in the others. Results The procedure was completed in all the 23 patients within （93.9 ± 38.6） min. The mean intraoperative blood loss was （55.2 ± 18.6） ml. Total thymectomy was made in 19 cases, the other four patients received resection of the middle （ 1 case） or posterior （3 cases） mediastinal tumor, respectively. No patient died or was converted to open surgery. Postoperative pathological examination showed thymoma in 16 cases, schwannoma in 3, thymic cyst in 2, thymic hyperplasia in l, and bronchogenic cyst in 1. The patients were followed up for 1 to 48 months with a mean of 20 months, during which no recurrent cases were detected. Conclusion Da Vinci surgical system is feasible and safe for resection of mediastinal tumor.