机器人手术与传统胸腔镜手术治疗后纵隔神经源性肿瘤的对比研究

A Comparative Study Between Robot-assisted Thoracoscopic Surgery and Conventional Thoracoscopic Surgery for Posterior Mediastinal Neurogenic Tumors

目的 比较机器人手术(robot-assisted thoracoscopic surgery, RATS)与传统胸腔镜手术(video-assisted thoracoscopic surgery, VATS)治疗后纵隔神经源性肿瘤的短期疗效及安全性。方法 回顾性分析2014年6月~2022年8月同一术者完成的75例胸腔镜治疗后纵隔神经源性肿瘤的临床资料。其中RATS组37例,肿瘤直径(4.34±1.25)cm;VATS组38例,肿瘤直径(4.33±1.58)cm。术前均使用MRI或增强CT定位评估肿瘤。比较2组手术指标。结果 2组均成功完成后纵隔神经源性肿瘤切除,无围手术期死亡。与VATS组相比,RATS组总手术时间短[(72.3±17.2)min vs.(81.7±14.5)min,t=-2.567,P=0.012],术中出血量少[(49.6±20.8)ml vs.(71.1±13.1)ml,t=-5.355,P=0.000],术后24 h胸腔引流量少[(68.9±28.1)ml vs.(82.4±21.3)ml,t=-2.340,P=0.022],术后住院时间短[(3.2±1.3)d vs.(4.3±1.1)d,t=-3.699,P=0.000],但住院费用高[(5.2±0.3)万元vs.(3.8±0.3)万元,t=23.193,P=0.000]。2组中转开胸、术后胸腔引流时间和并发症发生率差异无统计学意义(P>0.05)。结论 与VATS相比,RATS治疗后纵隔神经源性肿瘤在手术时间、术中出血量、术后胸腔引流量和术后住院时间方面具有优势。

Objective To compare the short-term efficacy and safety of robot-assisted thoracoscopic surgery(RATS) with conventional video-assisted thoracoscopic surgery(VATS) for posterior mediastinal neurogenic tumors. Methods We retrospectively analyzed the clinical data of 75 patients with mediastinal neurogenic tumors after thoracoscopic surgery completed by the same operator from June 2014 to August 2022. There were 37 patients in the RATS group, with a tumor diameter of(4.34±1.25) cm, and 38 patients in the VATS group, with a tumor diameter of(4.33±1.58) cm. The tumors were localized and evaluated in all the patients preoperatively by using MRI or enhanced CT. The operative indexes of the two groups were compared. Results Resection of posterior mediastinal neurogenic tumor was successfully completed in both groups without perioperative deaths. Compared with the VATS group, the RATS group got a shorter total operative time [(72.3±17.2) min vs.(81.7±14.5) min, t=-2.567, P=0.012], less intraoperative bleeding [(49.6±20.8) ml vs.(71.1±13.1) ml, t=-5.355, P=0.000], less postoperative chest drainage within 24 h [(68.9±28.1) ml vs.(82.4±21.3) ml, t=-2.340, P=0.022], and shorter postoperative hospital stay [(3.2±1.3) d vs.(4.3±1.1) d, t=-3.699, P=0.000]. But the hospitalization expense in the RATS group was higher [(5.2±0.3)×10~4 yuan vs.(3.8±0.3)×10~4 yuan, t=23.193, P=0.000]. No statistically significant difference between the two groups was found in terms of intermediate chest opening, postoperative chest drainage time, and complication rate(P>0.05). ConclusionCompared to the VATS, the RATS for posterior mediastinal neurogenic tumors has advantages in total operative time, intraoperative bleeding, chest drainage volume and postoperative hospital stay.