高龄患者行达芬奇机器人与胸腔镜肺癌根治手术的病例对照研究

Da Vinci Robot System versus Video-assisted Thoracoscopy for the Senile Patients with Radical Surgery of Lung Cancer:A Case Control Study

目的评估应用机器人手术系统为高龄患者行肺叶切除术的可行性和安全性。方法沈阳军区总医院胸外科在2012年5月至2015年3月期间共为25例70岁以上患者施行机器人肺癌根治术治疗作为机器人组,男17例、女8例,年龄(72.6±2.5)岁,筛选同期行胸腔镜肺癌根治术治疗高龄肺癌患者25例作为胸腔镜组,男17例、女8例,年龄(72.5±2.4)岁。两组患者均行肺叶切除术同期行肺门、纵隔淋巴结清扫术,比较两组疗效差异。结果两组患者全部为肺恶性肿瘤。机器人组25例患者在机器人下完成手术,手术完成率100%;胸腔镜组25例,1例中转为开胸手术。两组患者术中失血量[(66.2±44.2)ml vs.(356.0±349.2)ml,P=0.000]、清扫淋巴结数量[(23.2±9.8)个vs.(11.3±5.6)个,P=0.012]及术后卧床时间[(3.5±0.9)d vs.(4.2±1.1)d,P=0.017]差异有统计学意义,机器人组优于胸腔镜组。结论达芬奇机器人手术系统对于高龄患者行肺癌根治术手术治疗安全、有效,且较胸腔镜手术创伤更小,患者恢复更快。

Objective To evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with pulmonary lobectomy.Methods We retrospectively analyzed the clinical data of 50 patients in General Hospital of Shenyang Military Region of Thoracic Surgery between May 2012 and March 2015.The patients were divided into two groups.Twenty five patients aged over 70 years underwent radical operation of lung cancer with da Vinci Robot System were allocated into a robot group with 17 males and 8 females at age of 72.6 ± 2.5 years.Another 25 senile patients with radical surgery by video-assisted thoracoscopic surgery(VATS) were allocated into a thoracoscopic group with 17 males and 8 females at age of 72.5±2.4 years.The patients in the two groups underwent pulmonary lobectomy and mediastinal lymph node dissection.The clinical effect of the two groups was compared.Results All patients were diagnosed as lung cancer.Twenty five patients all completed surgery under da Vinci Robot System in the robot group.In the thoracoscopic group,one patient was converted to thoracotomy.There were statistical differences in amount of blood loss(66.2±44.2 ml vs.356.0±349.2 ml,P=0.000),lymph node number(23.2±9.8 vs.11.3±5.6,P=0.012),and postoperative bed time(3.5±0.9 d vs.4.2±1.1 d,P=0.017) between the two groups.Effect in the robot group was superior to that in the thoracoscopic group.Conclusions Da Vinci robotic surgery system for elderly patients with lung cancer radical surgery is safe,effective,and less thoracoscopic surgery trauma,recovery faster.