经前侧入路机器人辅助肺叶切除术180例临床分析

Clinical analysis of robot-assisted lobectomy through anterior approach in 180 patients

目的总结分析经前侧入路达芬奇机器人辅助肺叶切除术(RAL)的临床应用价值。方法回顾性分析2017年4月至2018年2月采用前侧入路RAL 180例患者的临床资料,其中男97例、女83例,中位年龄59.5(32.0~83.0)岁。分析其临床效果。结果全组病例均顺利完成手术,因肿瘤侵犯邻近血管,且肺门纵隔淋巴结肿大融合并包绕血管损伤出血而中转开胸1例,无围手术期死亡。中位手术时间为120(50~360)min,其中Docking时间5(1~23)min,机器人腔内操作时间65(7~270)min;中位出血量50(5~1500)mL,恶性肿瘤132例(73.3%),中位淋巴结清扫个数8.5(1.0~35.0)个,术后中位胸腔引流时间5(2~30)d,术后平均疼痛评分(3.4±0.7)分,术后中位住院时间8(2~32)d。中位随访时间24个月,11例出现复发转移,3例死亡。结论经前侧入路RAL安全、便捷和有效,值得临床推广应用。

Objective To evaluate the feasibility and clinical value of robot-assisted lobectomy through anterior approach.Methods We retrospectively analyzed the clinical data of 180 patients who underwent robot-assisted lobectomy through anterior approach in our hospital between April 2017 and February 2018.There were 97 males and 83 females,aged 59.5(32.0-83.0)years.The clinical effects were analyzed.Results One patient was transferred to thoracotomy due to tumor invasion of adjacent blood vessels and injury to the blood vessels,and there was no perioperative death.There were 8.5(1.0-35.0)dissected lymph nodes for each patient.The median operation time was 120(50-360)min,including robot Docking time 5(1-23)min and robot operation time 65(7-270)min.The median blood loss was 50(5-1500)mL,132(73.3%)patients had malignant tumors and median drainage time was 5(2-30)d.The mean postoperative pain score was 3.4±0.7 points and the postoperative hospital time was 8(2-32)d.At the median follow-up of 24 months,11 patients developed recurrence and metastasis,and 3 died.Conclusion Robot-assisted lobectomy through anterior approach is a safe and convenient operation method,which is worthy of clinical application.