完全无管达芬奇机器人手术系统在纵隔肿瘤手术中应用

The totally no-tube Da Vinci robotic surgical system was used in mediastinal tumor surgery

目的探讨完全无管达芬奇机器人手术系统在纵隔肿瘤手术中应用的安全性及有效性。方法选取自2016年4月13日至2017年4月28日经影像学诊断考虑为纵隔肿瘤,且拟采用完全无管达芬奇机器人手术系统治疗的63例患者为研究对象。观察患者围术期情况、手术术式及病理诊断,并对患者预后情况进行随访。结果患者均顺利完成手术,术中生命体征正常、平稳,平均手术时长(切皮至缝合完毕)为(58.95±23.47)min,术中平均出血量为(11.24±9.12)ml,肿物直径0.6~9.6 cm。其中,3例患者因安全考虑选择留置胸引管,完全无管达芬奇机器人手术完成率为95.2%(60/63)。完全无管达芬奇机器人手术术式:全胸腺切除、纵隔脂肪清除3例(5.0%),全胸腺切除(含肿物)3例(5.0%),胸腺大部切除(含肿物)7例(11.7%),肿物切除47例(78.3%)。经右胸操作43例(71.7%),经左胸操作17例(28.3%)。行完全无管达芬奇机器人手术患者病理诊断:良性51例(85.0%),恶性9例(15.0%)。患者术后恢复顺利,次日离床活动并复查胸X线影像检查,未见需行胸腔穿刺或闭式引流患者,最短出院时间为术后次日,最长为术后第13天,平均出院时间(3.57±2.17)d。留置胸引管患者,2例于术后第1天拔出,1例于术后第3天拔出,并分别于术后第3天、第7天、第5天出院。随访结果显示,1例恶性病变患者失访,其余患者均无疾病进展或复发、转移。结论完全无管达芬奇机器人系统在纵隔肿瘤手术中安全性好,手术成功率高,创伤较小。

Objective To investigate the feasibility,safety and reliability of totally no-tube(TNT)of Da Vinci surgical system in the treatment of mediastinal tumor.Methods A retrospective study was performed on 63 cases of patients who were imaging diagnosed as mediastinal tumor who were admitted and underwent TNT of Da Vinci surgical system from April 13,2016 to April 28,2017.The perioperative,operative and pathological diagnosis of the patients were observed,and the prognosis of the patients was followed up.Results All patients successfully completed the surgery,with normal and stable intraoperative vital signs.The average duration of the operation(from skin cutting to the completion of suture)was(58.95±23.47)minutes,the average intraoperative blood loss was(11.24±9.12)ml,and the diameter of the tumor was 0.6 cm to 9.6 cm.Among them,3 patients chose indwelling thoracic catheter due to safety considerations,and the completion rate of completely tubeless Da Vinci robot surgery was 95.2%(60/63).Complete ductless Da Vinci robotic surgery:total thymectomy and mediastinal fat removal in 3 cases(5.0%),total thymectomy 3 cases(5.0%),subtotal thymectomy 7 cases(11.7%),and tumor resection in 47 cases(78.3%).Among them,43 cases(71.7%)underwent right thoracic manipulation,and 17 cases(28.3%)underwent left thoracic manipulation.Pathological diagnosis of patients undergoing complete ductless Da Vinci robotic surgery:benign in 51 cases(85.0%),malignant in 9 cases(15.0%).The patient recovered well after the operation,got out of bed the next day,and re-examined the chest X-ray examination.No chest puncture or closed drainage was required.The shortest discharge time was the next day after the operation,the longest was the 13 th day after the operation,and the average discharge time(3.57±2.17)days.Among the patients with indwelling thoracic catheter,2 cases were pulled out on the first day after surgery,1 case was pulled out on the third day after surgery,and they were discharged from hospital on the third day,the seventh day,and the fifth day after surgery,respectively.Follow-up results showed that 1 patient with malignant lesions lost follow-up,and the rest of the patients had no disease progression,recurrence or metastasis.Conclusion The TNT of Da Vinci robot operation is feasible safe and lesser trauma for resection of mediastinal tumor.