58例达芬奇机器人系统辅助肺部手术的临床分析

Clinical analysis of 58 cases of Da Vinci robot system-assisted pulmonary surgery

目的探讨及总结采用达芬奇机器人系统行肺部手术的初期经验。方法回顾性收集西安交通大学第一附属医院胸外科行达芬奇机器人手术系统辅助肺部手术病例的临床资料并进行统计分析。结果 2016年3月-2017年11月我院应用达芬奇机器人系统行肺部手术58例,其中男42例,女16例,年龄25～79(59±11)岁。所有病例均顺利完成机器人手术,包括肺叶切除41例,肺段切除7例,肺楔形切除6例,肺袖式切除2例,联合肺段切除、楔形+肺段各1例;术后病理诊断为良性病变17例,肺癌41例;手术时间分别为,肺叶切除(169.93±66.88)min,肺段切除(165.43±56.37)min;术中清扫淋巴结5～26(15.1±8.7)枚;术后留置胸腔引流管2～15(6.0±2.6)d,术后住院时间2～21(7.95±3.23)d。除1例患者出现支气管胸膜瘘接受二次手术外,余均无严重术后并发症,顺利出院。患者住院期间总费用为32 015.57～127 087.89(78 483.19±15 925.18)元。结论达芬奇机器人系统辅助肺部手术在具有丰富常规胸腔镜手术经验的医疗中心可顺利开展,其效果安全、可行,并且在一些复杂操作中具有优势,但是相对昂贵的费用是限制其使用的一个重要因素。

Objective To explore the safety,feasibility and clinical value of Da Vinci robot system-assisted pulmonary surgery. Methods The clinical data of Da Vinci robot system-assisted pulmonary surgery in our department were collected retrospectively and analyzed. Results From March 2016 to November 2017,we enrolled 58 patients (42 males and 16 females,mean age 59±11 years) for the robotic system-assisted pulmonary surgery at our hospital.All surgeries were successfully completed,which consisted of lobectomy in 41 cases,segmentectomy in 7 cases,pulmonary wedge-shaped resection in 6 cases,pulmonary sleeve resection in 2 cases,combined resection in 1 case,and wedge-shaped resection & segmentectomy in 1 case.The postoperative diagnosis was benign lesions in 17 cases,and lung cancer in 41 cases.The average operation time was 169.93±66.88 mins for lobectomy and 165.43±56.37 mins for segmentectomy.The lymph node resection ranged from 5 to 26 pieces (mean of 15.1±8.7 pieces).The postoperative drainage time ranged from 2 to 15 days (mean of 6.0±2.6 days) and hospitalization time was 2 to 21 days (mean of 7.95±3.23 days).All but one patient recovered smoothly and were discharged with the total cost ranging from 32 015.57 to 127 087.89 yuan (mean of 78 483.19 ±15 925.18 yuan).The patient with bronchopleural fistula after resection was successfully treated with lobectomy. Conclusion Da Vinci robotic system-assisted pulmonary surgery can be performed successfully in a center with extensive experience in thoracoscopic surgery.It is safe,feasible and advantageous in some complex operations,but the relatively expensive cost is an important factor that affects its wide application.