机器人辅助解剖性肺基底段切除术临床应用的回顾性分析

Application of robot-assisted lung basal segmentectomy:A retrospective study

目的总结分析机器人辅助下肺基底段切除的临床应用效果,以及单向式和双向式入路在后外基底段切除中的应用价值。方法回顾性分析2020年1月—2022年5月于陆军军医大学大坪医院胸外科行机器人辅助下肺基底段切除78例患者的临床资料,其中男32例、女46例,中位年龄50(33~72)岁。38例患者行后、外或后外联合基底段切除,其中19例经下肺静脉单向式入路,19例经叶间裂双向式入路完成手术,比较两组患者的临床资料。结果所有病例均顺利完成手术,无严重并发症,无中转开胸,无围手术期死亡。中位手术时间100(40~185)min、术中出血量50(10~210)mL、淋巴结采样个数3(1~14)枚。术后4例(5.1%)肺漏气,4例(5.1%)液气胸。术后6个月复查均无肺淤血及局限性肺不张。单向式和双向式入路的后外基底段切除患者手术时间、术中出血量、胸腔引流管留置时间、术后住院时间以及并发症等指标差异均无统计学意义(P>0.05);而在淋巴结采样个数方面,双向式组较单向式组多,差异有统计学意义[6(1~13)枚vs.5(1~9)枚,P=0.040]。结论机器人辅助复杂肺基底段切除安全有效,其中后外基底段切除术中单向式和双向式入路围手术期结果相似。

Objective To summarize the experience of robot-assisted lung basal segmentectomy,and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy.Methods The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed.There were 32 males and 46 females with a median age of 50(33-72)years.The patients who underwent S^(9)and/or S^(10)segmentectomy were divided into a single-direction group(pulmonary ligament approach,n=19)and a bi-direction group(intersegmental tunneling,n=19)according to different approaches,and the perioperative outcomes between the two groups were compared.Results All patients successfully completed the operation,without conversion to thoracotomy and lobectomy,serious complications,or perioperative death.The median operation time was 100(40-185)min,the blood loss was 50(10-210)mL,and the median number of dissected lymph nodes was 3(1-14).There were 4(5.1%)patients with postoperative air leakage,and 4(5.1%)patients with hydropneumothorax.No patient showed localized atelectasis or lung congestion at 6 months after the operation.Further analysis showed that there was no significant difference in the operation time,blood loss,thoracic drainage time,complications or postoperative hospital stay between the single-direction and bi-direction groups(P>0.05).However,the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group[6(1-13)vs.5(1-9),P=0.040].Conclusion The robotic lung basal segmentectomy for pulmonary nodules is safe and effective.The perioperative results of robotic S^(9)and/or S^(10)complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.