达芬奇机器人与电视胸腔镜手术治疗纵隔肿瘤的临床对比研究

Clinical Comparative Study of Da Vinci Robot and Video-assisted Thoracoscopic Surgery in the Treatment of Mediastinal Tumors

目的 比较达芬奇机器人手术和电视胸腔镜手术在纵隔肿瘤治疗中的围手术期疗效和分析二者的安全性,总结本中心微创纵隔肿瘤切除术的经验。方法 采用回顾性队列研究的方法,连续性纳入2015年3月至2021年11月由我科同一医疗组行纵隔肿瘤切除术的134例患者。根据手术方式将患者分为两组:达芬奇机器人组(n=66)和普通电视胸腔镜组(n=68)。比较分析两组患者的手术总时间、术中失血量、胸腔引流管留置时间、术后胸腔引流液总量、术后住院时间、术后并发症发生率等临床资料。结果两组患者均完成预期病灶切除,其中达芬奇机器人组1例中转开胸,普通胸腔镜组5例中转开胸,无术后非计划二次手术、围手术期死亡等严重并发症。手术总时间:达芬奇机器人组109.5(45~370)min,电视胸腔镜组90.5(25~300)min;术中失血量:达芬奇机器人组50(5~200)mL,电视胸腔镜组50(5~900)mL;术后住院时间:达芬奇机器人组4(2~12)d,电视胸腔镜组4(1~15)d,以上指标两组间差异无统计学意义(P> 0.05)。术后胸腔引流液总量:达芬奇机器人组300(60~880)m L,电视胸腔镜组405(20~3 090)mL,差异有统计学意义(P=0.012);胸腔引流管留置时间:达芬奇机器人组2(1~9)d,电视胸腔镜组3(1~10)d,差异有统计学意义(P=0.031)。在术后总并发症发生率方面,达芬奇机器人组术后总并发症发生率明显低于电视胸腔镜组(3/66 vs. 13/68),差异有统计学意义(P=0.009)。结论 达芬奇机器人手术系统行纵隔肿瘤切除术安全可靠,与普通电视胸腔镜手术相比,术后胸腔引流液总量更少,术后胸腔引流管留置时间缩短,术后并发症发生率更低,提高了患者手术效果满意度。

Objective To compare the perioperative efficacy and safety of Da Vinci robot-assisted surgery and video-assisted thoracoscopy in mediastinal tumortreatment,and summarize the experience of minimally invasive mediastinal tumor resectionin our center. Methods A retrospective cohort study was conducted to continuously include 134 patients who underwent mediastinal tumor resection in the single medical group in our department from March 2015 to November 2021. Patients were divided into two groups according to the surgical method: the Da Vinci robot-assisted group(n=66) and the general video-assisted thoracoscopy group(n=68). The total operative time, intraoperative blood loss, chest drainage tube indwelling time, postoperative thoracic drainage fluid volume, postoperative hospital stay, postoperative complication rate and other clinical data of the two groups were compared and analyzed. Results Expected resection of lesions was completed in both groups, and thoracotomy was transferred to 1 case in the Da Vinci robot-assisted group and 5 cases in the general video-assisted thoracoscopy group. No postoperative unplanned secondary surgery, perioperative death and other serious complications were observed. The total operation time was 109.5(45-370) min in the Da Vinci robot-assisted group and 90.5(25-300) min in the general video-assisted thoracoscopy group.Intraoperative blood loss was 50(5-200) mL in the Da Vinci robot-assisted group and 50(5-900) mL in the general video-assisted thoracoscopy group.Postoperative hospital stay was 4(2-12) d in the Da Vinci robot-assisted group and 4(1-15) d in the general videoassisted thoracoscopy group. There was no significant difference in the above indexes between the two groups(P>0.05).The total amount of postoperative thoracic drainage fluid was 300(60-880) mL in the Da Vinci robot-assisted group and 405(20-3 090) mL in the general video-assisted thoracoscopy group,the difference being statistically significant(P=0.012). The indentation time of thoracic drainage tube was 2(1-9) days in the Da Vinci robot-assisted group and 3(1-10) days in the general video-assisted thoracoscopy group, and the difference was statistically significant(P=0.031). In terms of the total postoperative complication rate, the da Vinci robot group was significantly lower than the video-assisted thoracoscopy group(3/66 vs. 13/68), and the difference was statistically significant(P=0.009). Conclusion The Da Vinci robotic surgical system is safe and reliable for mediastinal tumor resection.Compared with general video-assisted thoracoscopic surgery, the total amount of postoperative thoracic drainage fluid is less, the duration of postoperative thoracic drainage tube indwells is shorter, the incidence of postoperative complications is reduced, and the satisfaction of surgical effect is improved.