机器人与胸腔镜在早期肺癌肺段切除术中短期疗效的对比研究

Comparative study on short-term outcomes of robot-assisted and video-assisted thoracoscopic surgery in lung segmentectomy

目的:分析机器人与胸腔镜手术在早期肺癌肺段切除中的临床疗效。方法:回顾性分析2019年1月~2020年12月在甘肃省人民医院接受达芬奇机器人和胸腔镜行肺段切除手术的106例早期肺癌患者的临床资料。其中接受RATS肺段切除术49例(男19例,女30例),年龄(59.13±9.38)岁;接受VATS 57例(男21例,女36例),年龄(60.36±10.06)岁,比较两组的临床疗效。结果:两组患者基线资料差异无统计学意义。RATS组与VATS组相比,手术时间(126.42min Vs 110.23min,P=0.007);术中失血量(40.46ml Vs 62.23ml,P=0.016);淋巴结清扫站数总数(6.32 Vs 5.21,P<0.001);淋巴结清扫总数(13.29 Vs 10.81,P=0.023);术后引流时间(4.29d Vs 5.66d,P=0.005);总引流量(772.53ml Vs 995.34ml,P=0.011);术后第1d疼痛评分(1.67 Vs 2.59,P=0.031)、第2d(2.74 Vs 3.71,P=0.025)、第3d(1.02 Vs 1.92,P=0.006);术后住院时间(4.45d Vs 6.39d,P=0.008);住院费用(90463.37元Vs 69872.21元,P<0.001),差异有统计学意义。而中转开胸手术、术后咳嗽、术后并发症、术后30d再入院率差异无统计学意义(P>0.05)。结论:机器人手术系统在早期肺癌肺段切除术中,术中出血量少,住院时间短,淋巴结清扫优势大,术后疼痛感轻,操作安全有效且创伤小,可作为早期肺癌手术治疗的有效方法。

Objective:To compare the short-term clinical efficacy of robot-assisted thoracoscopic surgery(RATS)and video-assisted thoracoscopic surgery(VATS)in segmental resection for early lung cancer.Methods:Clinical data of 106 patients with lung cancer who underwent RATS and VATS in Gansu Provincial Hospital from January 2019 to December 2020 were retrospectively analyzed.RATS group has 49 patients,including 19 males and 30 females,with a median age of(59.13±9.38)years.57 patients in VATS group,including 21 males and 36 females,with a median age of(60.36±10.06)years.The clinical efficacy of the two groups was compared.Results:No statistically significant difference in terms of baseline data between the two groups was found.Compared to the VATS group,the RATS group had a longer operative time(126.42min Vs 110.23min,P=0.007),less intraoperative blood loss(40.46 ml Vs 62.23 ml,P=0.016),more groups of lymph node dissection(6.32 Vs 5.21,P<0.001)and total number of lymph node dissection(13.29 Vs 10.81,P=0.023).The RATS group also had a shorter duration of chest drainage(4.29d Vs 5.66d,P=0.005)and less total thoracic drainage volume(772.53ml Vs 995.34ml,P=0.011).The postoperative pain scores 1 day after surgery of RATS group and VATS group were(1.67 Vs 2.59,P=0.031),2 days after surgery were(2.74 Vs 3.71,P=0.025)and 3 days after surgery were(1.02 Vs 1.92,P=0.006)respectively.RATS group had a shorter postoperative hospitalization than VATS group(4.45 days Vs 6.39 days,P=0.008)but more hospital expenses(90463.37 CNY Vs 69872.21 CNY,P<0.001),the difference was statistically significant.However,there was no significant difference on conversion rate to thoracotomy,postoperative chronic cough,postoperative complications and readmission 30 days after surgery(P>0.05).Conclusion:Robotic surgery system has a lower intraoperative blood loss,shorter hospital stay,more lymph node dissection,less postoperative pain and smaller incisions,it is safe and effective in the segmental resection for early stage of lung cancer.