达芬奇机器人完全无管化与经剑突下胸腔镜手术治疗胸腺肿瘤围手术期效果的回顾性队列研究

Perioperative effects of da Vinci robot with totally no tube versus subxiphoid videoassisted thymectomy surgery for thymic tumors:A retrospective cohort study

目的比较达芬奇机器人完全无管化(totally no tube,TNT)与经剑突下胸腔镜手术(subxiphoid video-assisted thymectomy surgery,SVATS)治疗胸腺肿瘤的临床疗效与安全性。方法回顾性分析2019—2021年北部战区总医院胸外科连续收治胸腺肿瘤切除术435例患者的临床资料,所有患者均行胸腺全切术及纵隔脂肪清除。按手术方式将患者分为TNT组及SVATS组。比较两组患者术中出血量、中转开胸率、术后视觉模拟评分(visual analogue score,VAS)、术后住院时间、术后并发症等围术期指标。结果TNT组168例,其中男83例、女85例,平均年龄(61.920±9.210)岁;SVATS组267例,其中男147例、女120例,平均年龄(61.460±8.119)岁。两组患者均无围术期死亡及术后肌无力危象,两组患者术后住院时间[(1.540±0.500)d vs.(3.400±0.561)d,P=0.000]、术中出血量[(13.450±5.498)mL vs.(108.610±54.462)mL,P=0.000]、术后24 h VAS评分[(4.960±1.757)分vs.(3.600±1.708)分,P=0.000]、术后并发症发生率[(5/168,3.0%)vs.(31/267,11.6%),P=0.001]差异有统计学意义。结论TNT手术高效、安全,能够缩短术后住院时间,可明显减少术后并发症;SVATS可减轻患者术后疼痛。

Objective To compare the clinical efficacy and safety of da Vinci robot with total no tube(TNT)versus subxiphoid video-assisted thymectomy surgery(SVATS)in the treatment of thymic tumors.Methods From January 2019 to December 2021,a retrospective analysis was conducted on patients with thymic tumor resection in the Department of Thoracic Surgery,General Hospital of Northern Theater Command.All patients underwent total thymectomy and mediastinal fat removal,and they were divided into a TNT group and a SVATS group according to the operation method.The intraoperative blood loss,conversion rate,postoperative visual analogue score,postoperative hospital day time and postoperative complications were compared between the two groups.Results We finally included 435 patiets.There were 168 patients with 83 males and 85 females at average age of 61.920±9.210 years in the TNT group and 267 patients with 147 males and 120 females at average age of 61.460±8.119 years in the SVATS group.There was no death or postoperative myasthenic crisis in both groups.There was no statistical difference in postoperative hospital stay(1.540±0.500 d vs.3.400±0.561 d,P=0.000),intraoperative blood loss(13.450±5.498 mL vs.108.61±54.462 mL,P=0.000),postoperative 24 h VAS score(4.960±1.757 points vs.3.600±1.708 points,P=0.000),postoperative 24 h VAS score(4.960±1.757 points vs.3.600±1.708 points,P=0.000),or postoperative complication rate(2.9%vs.11.6%,P=0.001).However,SVATS can minimize postoperative pain.Conclusion TNT is a more efficient,safe,and effective surgical approach for treating thymic tumors,with a lower risk of thoracotomy conversion and postoperative problems.However,SVATS can minimize postoperative pain.