达芬奇机器人手术系统在胸外科纵隔肿瘤切除术中的应用体会

Application of da Vinci Surgical System to treatment of mediastinal tumor

目的总结达芬奇机器人手术系统在胸外科纵隔肿瘤切除术中的应用经验。方法回顾分析2011年3月--2012月10月间，我科应用达芬奇机器人手术系统切除胸部纵隔肿瘤65例的临床资料。手术采用三臂法，即一个镜头臂，两个操作臂，不设辅助口，建立8mmHg人工气胸。根据肿瘤的位置和大小等情况选择切口位置。对手术操作时间、术中出血量、术后拔管时间等情况进行统计分析，并对手术患者体位、如何选取适宜的手术切口部位进行总结。结果本组65例纵隔肿瘤中：实性肿瘤41例，囊肿24例。其中64例顺利应用达芬奇机器人手术系统完成肿瘤切除，1例联合电视胸腔镜系统顺利完成肿瘤切除术。手术时间为3～210（50．63±46．35）min，术中出血量为0～200（22．62±33．64）ml，胸引管拔出时间为术后第1～14（4．02±2．62）天。所有患者均恢复顺利出院。术后随访1～21（7．61±4．58）个月，所有患者目前恢复良好，无复发。结论应用达芬奇机器人手术系统治疗胸外科纵隔肿瘤，具有手术更加安全、术中出血量少、术后带管时间短、患者痛苦轻、住院时间短等优势。必要时，将达芬奇手术机器人系统与电视胸腔镜系统联合应用，可取得更佳的手术治疗效果。

Objective To summarize the initial experience in robot assisted mediastinal tumor resection. Methods A total of 65 patients underwent mediastinal tumor resection using da Vinci Surgical System （made by Intuitive Surgical, California） in our de- partment from March 2011 to October 2012. Three arms were used in the procedure and the positions of trocars were designed ac- cording to the site and size of tumor. Without accessory port, artificial pneumothorax （8 mmHg） was established. We retrospective- ly analyzed the data of operating time, blood loss, time of postoperative drainage, and so on, and summarized the experience how to position the patients and how to choose the optimal incisions. Results Of the 65 cases of mediastinal tumor, there were 41 cases of solid tumors and 24 cases of cysts, and 64 cases were completed by totally robot assisted approach and the other one combined with thoracoscopic surgery. The mean operating time was 3 - 210 （50.63 ± 46.35 ） min. The mean intra - operative blood loss was 0 -200 （22.62 ± 33, 64） ml. The mean postoperative drainage time was 1 -14 （4.02 ± 2.62）d. All the patients recovered and were discharged smoothly. Histological findings showed that all the cases were benign lesions except one with low grade malignant lesion that received adjuvant radiotherapy. The patients were followed up for 1 -21 （7.61 ± 4.58 ） month（ s）, without complica- tion or recurrence. Conclusion The da Vinci robotic surgery leads to not only short operation time, postoperative drainage time and hospital stay, but also less blood loss and pain. Combined da Vinci robotic surgical system with video assisted thoracoscopy helps to achieve a better outcome for the treatment of mediastinal tumors.