机器人辅助胸腔镜技术在儿童纵隔肿瘤切除术中的应用

Applications of robot-assisted thoracoscopic surgery for mediastinal tumors in children

目的探索机器人辅助胸腔镜治疗儿童纵隔肿瘤的疗效并总结经验。方法收集2020年4月至2021年3月在浙江大学医学院附属儿童医院行机器人辅助胸腔镜下纵隔肿瘤切除术的17例患儿的临床资料,其中男13例,女4例,年龄(6.0±3.4)岁,范围8个月至13岁,体重(24.5±13.1)kg,体重范围为7.5~61 kg,肿瘤直径(5.2±2.4)cm。考察手术时间、术中出血量、术后住院时间、术后胸腔引流时间、住院费用、术后并发症及随访情况等。结果本组所有患儿均完整切除肿瘤,无中转开胸,无围术期死亡。手术时间(99.0±39.3)min,术中出血量(2.5±2.3)ml,术后住院时间(6.9±5.2)d,胸腔引流时间(4.3±4.8)d,平均住院费用67131.2元。术后有2例出现乳糜胸,2例出现Horner综合征。全组随访1~12个月,均恢复良好,肿瘤无复发。结论机器人辅助胸腔镜手术治疗儿童纵隔肿瘤安全可行,其具有灵活、精准、稳定的特点,对患儿的创伤小,术后恢复快,在小儿胸外科具有较好的临床应用前景。

Objective To evaluate the efficacy of robot-assisted thoracoscopic surgery(RATS)for mediastinal tumors in children and to summarize the preliminary experiences.Methods From April 2020 to March 2021,retrospective analysis was performed for clinical data of 17 children undergoing RATS for mediastinal tumor resection.There were 13 boys and 4 girls with an age of(6.0±3.4)years and a body weight of(24.5±13.1)kg.The diameter of tumor was(5.2±2.4)cm.Baseline profiles,intraoperative findings and follow-up observations were recorded.Results Complete resection of tumor was performed without conversion into thoracotomy or perioperative mortality.The average operative duration was(99.0±39.3)min,average intraoperative hemorrhage(2.5±2.3)ml,average postoperative hospital stay(6.9±5.2)days,thoracic drainage duration(4.3±4.8)days and average hospitalization expenditure 67131.2 yuan.The postoperative complications included chylothorax(n=2)and Horner's syndrome(n=2).During a follow-up period of 1 to 12 months,all of them recovered well without recurrence.Conclusion RATS is both safe and feasible for mediastinal tumors in children.It offers the advantages of flexibility,accuracy and stability.With minimal trauma and a rapid postoperative recovery,it has excellent application prospects in pediatric thoracic surgery.