纵隔囊肿的外科治疗:达芬奇机器人与电视胸腔镜手术比较

Surgical treatment of mediastinal cysts: da Vinci S surgical system vs VATS

目的总结和分享应用达芬奇机器人手术系统治疗纵隔囊肿的经验。方法回顾性分析我科2009年7月至2014年2月手术治疗并经术后病理证实为纵隔囊肿患者91例的临床资料。其中,应用电视胸腔镜手术切除39例,应用达芬奇机器人手术系统切除52例,分别对手术时间、术中出血量、引流时间、术后住院时间等情况进行统计分析比较。结果胸腔镜组1例术中见囊肿与右主支气管形成瘘口,行瘘口修补,术后发生脓胸,再次行脓胸清除术后恢复良好;机器人组2例术中见囊肿与食管关系密切,术中在胃镜辅助下行囊肿大部切除。其余患者均顺利完成手术,恢复良好,痊愈出院。手术时间：机器人组72（42~200）min,胸腔镜组100（48~275）min（Z=-4.110,P〈0.01）;术中出血量：机器人组5（0~50）ml,胸腔镜组30（0~600）ml（Z=-5.696,P〈0.01）;引流时间：机器人组2（1~9）d,胸腔镜组5（1~13）d（Z=-4.773,P〈0.01）;术后出院时间：机器人组（5.54±2.24）d,胸腔镜组（9.59±4.04）d（t=4.486,P〈0.05）。术后随访3~58个月,平均（26.75±15.99）个月,均恢复良好,无复发。结论与胸腔镜手术相比,应用达芬奇机器人手术系统治疗纵隔囊肿,具有手术更加安全、手术时间短、术中出血量少、术后引流时间短、术后住院时间短等优势。

Objective To summarize the experience of surgical treatment mediastinal cysts with da Vinci S Surgical System. Meth- ods To analyze the 91 cases with mediastinal cysts who underwent surgical treatment from July 2009 to February 2014,39 of which with VATS and 52 with da Vinci S surgical system. Data of operating time, blood loss, time of drainage and postoperative hospital stay were collected. Results There was fistula formation between the cyst and the right main bronchus of 1 patient in VATS group, and we repaired the fistula. After the second surgery of empyema clear beease of the postoperative empyema, the patient had good re- covery. Also,in robot group, the cyst was closely with the esophagus of 2 patient,we gave the excision of most cysts with the gastro- scope assistant. The remaining cases were completed surgery successfully, and were discharged with well recovery. Surgical time：ro- bot group 72 （42-200） minutes, VATS group 100 （48-275） minutes （ Z = - 4.110, P 〈 0.01 ）. Blood loss ： robot group 5 （ 0-50 ） ml, VATS group 30 （ 0-600 ） ml （ Z = - 5. 696, P 〈 0.01 ）. Time of drainage ： robot group 2 （ 1-9 ） days, VATS group 5 （ 1-13 ） days （ Z = - 4. 773 ,P 〈 0. 01 ）. Postoperative hospital stay ： robot group（ 5.54 ± 2.24） days, VATS group（9.59 ±4.04 ） days （ t = 4. 486, P 〈 0. 05 ）. Followed up was performed for 3-58 （26.75 ± 15.99）months postoperatively ,non recurrence was found in any cases. Con- clusion Compared with VATS,The da Vinci S surgical system can be safer used for the treatment of mediastinal cysts with shorter operating time, less blood loss, shorter time of drainage and postoperative hospital stay.