全孔机器人与胸腔镜纵隔肿物切除术近期疗效对比的倾向性评分匹配研究

Comparison of short-term outcomes between full-port robotic and thoracoscopic mediastinal tumor resection:A propensity score matching study

目的分析比较全孔达芬奇机器人手术与胸腔镜手术在纵隔肿物切除患者中的围手术期疗效差异。方法纳入2018年1月—2021年10月哈尔滨医科大学附属第二医院胸外科经同一术者连续完成的232例微创手术治疗纵隔肿物患者的临床资料,其中男103例(44.4%)、女129例(55.6%),平均年龄49.7岁。按手术方式分为机器人辅助胸外科手术(robot-assisted thoracic surgery,RATS)组(n=113)和电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)组(n=119)。按1∶1进行倾向性评分匹配后,RATS组和VATS组各纳入57例。结果术后第1 d视觉模拟评分[3.0(2.0,4.0)分vs.4.0(3.0,5.0)分]、术后住院时间[4.0(3.0,5.5)d vs.6.0(5.0,7.0)d]以及术后置管时间[2.0(2.0,3.0)d vs.3.0(3.0,4.0)d],RATS组明显优于VATS组(P<0.05)。术中出血量、术后并发症、术后胸腔闭式引流管置管率及术后总引流量方面,两组差异无统计学意义(P>0.05)。总住院费用[51271.0(44166.0,57152.0)元vs.35814.0(33418.0,39312.0)元]、手术费用[37659.0(32217.0,41511.0)元vs.19640.0(17008.0,21421.0)元]、麻醉费用[3307.0(2530.0,3823.0)元vs.2059.0(1577.0,2887.0)元]及药物和检查费用[9241.0(7987.0,12332.0)元vs.14143.0(11620.0,16750.0)元],RATS组明显高于VATS组(P<0.05)。结论机器人手术与胸腔镜手术均可安全有效完成;而机器人手术与胸腔镜手术相比,患者术后疼痛程度更轻、带管时间及术后住院时间更短,可明显加速患者术后康复;但机器人手术费用较胸腔镜手术费用高,加重了患者经济负担,这也是阻碍机器人手术普及的主要原因之一。

Objective To analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection.Methods The data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included.There were 103(44.4%)males and 129(55.6%)females,with an average age of 49.7 years.According to the surgical methods,they were divided into a robot-assisted thoracic surgery(RATS)group(n=113)and a video-assisted thoracoscopic surgery(VATS)group(n=119).After 1:1 propensity score matching,57 patients in the RATS group and 57 patients in the VATS group were obtained.Results The RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery[3.0(2.0,4.0)points vs.4.0(3.0,5.0)points],postoperative hospital stay time[4.0(3.0,5.5)d vs.6.0(5.0,7.0)d]and postoperative catheterization time[2.0(2.0,3.0)d vs.3.0(3.0,4.0)d](all P<0.05).There was no statistical difference between the two groups in terms of intraoperative blood loss,postoperative complications,postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume(all P>0.05).The total hospitalization costs[51271.0(44166.0,57152.0)yuan vs.35814.0(33418.0,39312.0)yuan],operation costs[37659.0(32217.0,41511.0)yuan vs.19640.0(17008.0,21421.0)yuan],anesthesia costs[3307.0(2530.0,3823.0)yuan vs.2059.0(1577.0,2887.0)yuan]and drug and examination costs[9241.0(7987.0,12332.0)yuan vs.14143.0(11620.0,16750.0)yuan]in the RATS group was higher than those in the VATS group(all P<0.05).Conclusion Robotic surgery and thoracoscopic surgery can be done safely and effectively.Compared with thoracoscopic surgery,robotic surgery has less postoperative pain,shorter tubecarrying time,and less postoperative hospital stay,which can significantly speed up the postoperative recovery of patients.However,the cost of robotic surgery is higher than that of thoracoscopic surgery,which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.