机器人胸腔镜解剖性肺段切除术治疗小儿肺疾病:5例报告

Robot-assisted Thoracoscopic Anatomic Segmentectomy in Children With Pulmonary Anomaly:a Report of 5 Cases

目的探讨机器人胸腔镜解剖性肺段切除术治疗小儿肺疾病的安全性。方法2020年1月~2021年12月我们对5例小儿肺疾病采用三臂四孔法,在机器人辅助胸腔镜下解剖并处理肺段级动脉、静脉及支气管,精准切除病变。结果5例均顺利完成手术,无中转开放手术。连机时间平均17.8 min(12~23 min),机器人手术时间平均134.0 min(60~180 min),术中出血量平均25.0 ml(5~50 ml),胸管保留时间平均2.0 d(1~3 d),术后住院时间平均6.8 d(5~9 d)。1例无症状性气胸,无胸腔积液、肺部感染、病灶残留等并发症。5例随访时间9~19个月,平均13个月,无胸腔积液、肺部感染、病灶残留等并发症。结论机器人应用于10 kg以上体重的小儿解剖性肺段切除术是安全可行的。

Objective To explore the safety of robotic thoracoscopic anatomical segmentectomy for congenital pulmonary anomalies in children.Methods From January 2020 to December 2021,we dissected the segmental pulmonary arteries,veins and bronchi under the robot-assisted thoracoscope so as to accurately removed the lesions,by using the“three arms,four ports”technique.Results All the operations were successfully completed in the 5 patients,and there was no conversion to open surgery.The docking time was 17.8 min(range,12-23 min),the average robot operation time was 134.0 min(range,60-180 min),and the average intraoperative bleeding was about 25.0 ml(range,5-50 ml).The chest tube duration time was 2.0 d(range,1-3 d),and the postoperative hospital stay was 6.8 d(range,5-9 d).One case got asymptomatic pneumothorax without pleural effusion,pulmonary infection or residual lesions.All the 5 patients were followed up for 9-19 months(mean,13 months)and there were no complications such as pleural effusion,pulmonary infection or residual lesions.Conclusion It is safe and feasible to apply robot for anatomical segmentectomy in children weighing more than 10 kg.