机器人与胸腔镜肺段切除术的病例对照研究

Robotic versus thoracoscopic lung segmentectomy:a case control study

目的总结本中心微创肺段切除术的经验,比较机器人与胸腔镜下肺段切除术患者的临床资料,评价机器人肺段切除术的临床价值。方法采用回顾性队列研究方法,连续纳入陆军军医大学大坪医院胸外科2018年6月至2019年10月行微创肺段切除术的患者,根据手术方式不同,分为机器人组(100例,男33例,女67例,中位年龄51岁)和胸腔镜组(90例,男34例,女56例,中位年龄54岁)。比较分析两组患者手术时间、术中出血量、术后胸腔引流液量和引流管带管时间、术后疼痛评分、术后并发症、术后住院时间和随访结果等资料。结果两组均顺利完成手术,无围术期死亡等严重并发症,顺利康复出院。两组患者性别、年龄、临床症状、吸烟情况、合并基础疾病、肿瘤大小、病理学类型等基线特征和切除肺段的类型差异无统计学意义(P>0.05)。机器人组和胸腔镜组比较,手术时间短[120(60~225)min对155(75~330)min],出血量少[30(20~400)ml对100(20~1600)ml],差异有统计学意义(P=0.000)。而两组术后引流管带管时间[4(1~15)天对4(2~29)天]、总引流量[755(200~3980)ml对815(280~3920)ml]、疼痛评分[2.33(0.88~4.75)分对3.13(0.95~5.29)分]、围手术期并发症发生率[7.4%(14/190)对6.3%(12/190)]、术后住院时间[7(3~19)天对6(4~21)天]等比较,差异无统计学意义(P>0.05),两组均安全有效且疗效相近;同时两组淋巴结清扫个数[(4.83±3.18)个对(6.15±4.1)个]差异无统计学意义(P>0.05);两组患者均进行随访,中位时间6.5(1~26)个月,均健康生存,无复发转移及死亡。结论机器人辅助肺段切除安全有效,能够减少手术时间和出血量,短期疗效与胸腔镜相近,远期疗效仍需进一步随访。

Objective To summarize the experience of robotic and thoracoscopic segmentectomy in Daping Hospital,Army Medical University,and comparison analysis the clinical application value for early-stage lung cancer.Methods A retrospective cohort study was conducted to continuously enroll 190 patients,100 who received robotic(33 males and 67 females,median age of 51 years)and 90 who received VATS(34 males and 56 females,median age of 54 years),who underwent segmentectomy between June 2018 and October 2019.Perioperative outcomes(the operation time,intraoperative blood loss,postoperative thoracic drainage volume and time,pain score,complications,postoperative hospital stay and survival and mortality)were compared.Results All the patients successfully completed the surgery and recovered from hospital,with no perioperative death.The baseline characteristics(sex,age,clinical symptoms,smoking status,underlying disease,tumor size,pathological type)and type of segmentectomy were comparable.There was significant difference in operative time[120(interquartile range,IQR 60-225)min vs.155(IQR 75-330)min,P<0.001],blood loss[30(IQR 20-400)ml vs.100(IQR 20-1600)ml,P<0.001]between the robotic and VATS groups,respectively.But there was no significant difference in postoperative thoracic drainagevolume[4(IQR 1-15)days vs.4(IQR 2-29)days,P=0.547],postoperative thoracic time[755(IQR 200-3980)ml vs.815(IQR 280-3920)ml,P=0.902],pain score[2.33(IQR 0.88-4.75)points vs.3.13(IQR 0.95-5.29)points,P=0.199],complications[7.4%(14/190)vs.6.3%(12/190),P=0.303],postoperative hospital stay[7(IQR 3-19)days vs.6(IQR 4-21)days,P=0.405],number of lymph nodes[(4.83±3.18)vs.(6.15±4.1),P=0.255]between the robotic and VATS groups,respectively.The follow-up time was 6.5(IQR 1-26)months in the two groups,without recurrence,metastasis or death.Conclusion Robotic lung segmentectomy is safe and feasible.This approach might lead to a better in operative time and blood loss.The short-term efficacy is similar with thoracoscopy,and the long-term efficacy needs further follow-up time.