达芬奇机器人手术治疗纵隔肿瘤的病例对照研究
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摘要
目的比较达芬奇机器人与电视胸腔镜手术治疗纵隔肿瘤的围手术期临床疗效差异。方法回顾性分析我院2016年1月至2017年10月共49例纵隔肿瘤患者的临床资料,根据患者自身经济条件自愿选择手术方式,其中有25例患者行机器人手术,为机器人组,男14例、女11例,年龄(56.5±17.9)岁;另外24例患者行电视胸腔镜手术,为电视胸腔镜组,男15例、女9例,年龄(53.0±17.8)岁。结果达芬奇机器人组和电视胸腔镜组手术时间差异无统计学意义(t=–0.365,P=0.681)。达芬奇机器人组术中出血量更少(t=–2.569,P<0.001),术后3 d引流量更少(t=–6.325,P=0.045),术后胸腔引流管拔管时间更短(t=–1.687,P=0.024)和术后住院时间更短(t=–3.689,P=0.021),术后48 h视觉模拟评分(VAS)更低(t=–7.214,P=0.014)。结论达芬奇机器人行纵隔肿瘤切除术是安全的,其手术时间与电视胸腔镜无较大差别,但在术后恢复方面,达芬奇机器人手术较电视胸腔镜手术有明显优势。
Objective To summarize the clinical data about mediastinal lesions, then to analyze the treatment effect of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods We retrospectively analyzed the clinical data of 49 patients with mediastinal lesions in our hospital between January 2016 and October 2017. These patients were divided into two groups including a da Vinci robot group and a video-assisted thoracoscopic surgery(VATS) group according to the selection of the treatments. There were 25 patients with 14 males and 11 females at age of 56.5±17.9 years in the da Vinci group and 24 patient with 15 males and 11 females at age of 53.0±17.8 years in the VATS group. Results There was no statistical difference in surgery time between the two groups(t=–0.365, P=0.681). Less intraoperative blood loss( t=–2.569, P<0.001), less postoperative drainage amount within three days after surgery( t=–6.325, P=0.045), shorter period of bearing drainage tubes after surgery( t=–1.687, P=0.024), shorter hospital stays( t=–3.689, P=0.021), lower visual analogue scale(VAS) scores of postoperative 48 hours(t=–7.214, P=0.014) with a statistical difference in the da Vinci robot group compared with the VATS group. Conclusion The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach.
Objective To summarize the clinical data about mediastinal lesions, then to analyze the treatment effect of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods We retrospectively analyzed the clinical data of 49 patients with mediastinal lesions in our hospital between January 2016 and October 2017. These patients were divided into two groups including a da Vinci robot group and a video-assisted thoracoscopic surgery(VATS) group according to the selection of the treatments. There were 25 patients with 14 males and 11 females at age of 56.5±17.9 years in the da Vinci group and 24 patient with 15 males and 11 females at age of 53.0±17.8 years in the VATS group. Results There was no statistical difference in surgery time between the two groups(t=–0.365, P=0.681). Less intraoperative blood loss( t=–2.569, P<0.001), less postoperative drainage amount within three days after surgery( t=–6.325, P=0.045), shorter period of bearing drainage tubes after surgery( t=–1.687, P=0.024), shorter hospital stays( t=–3.689, P=0.021), lower visual analogue scale(VAS) scores of postoperative 48 hours(t=–7.214, P=0.014) with a statistical difference in the da Vinci robot group compared with the VATS group. Conclusion The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach.
引文
1 Buentzel J,Straube C,Heinz J,et al.Thymectomy via open surgery or robotic video assisted thoracic surgery:Can a recommendation already be made?Medicine(Baltimore),2017,96(24):e7161.
2 Friedant AJ,Handorf EA,Su S,et al.Minimally invasive versus open thymectomy for thymic malignancies:systematic review and meta-analysis.J Thorac Oncol,2016,11(1):30-38.
3 杨胜利,茹婷巧,杨劼,等.单操作孔全电视胸腔镜手术在纵隔肿物切除中的应用.华中科技大学学报(医学版),2015,44(3):330-333.
4 陈世雄,陈胜家,许家君,等.单操作孔电视胸腔镜手术治疗前纵隔肿瘤.中国胸心血管外科临床杂志,2016,23(1):634-635.
5 Bodner J,Wykypiel H,Wetscher G,et al.First experiences with the da Vinci operating robot in thoracic surgery.Eur J Cardiothorac Surg,2004,25(5):844-851.
6 Bodner J,Wykypiel H,Greiner A,et al.Early experience with robot-assisted surgery for mediastinal masses.Ann Thorac Surg,2004,78(1):259-265.
7 Augustin F,Schmid T,Bodner J.The robotic approach for mediastinal lesions.Int J Med Robot,2006,2(3):262-270.
8 Marulli G,Schiavon M,Perissinotto E,et al.Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis.J Thorac Cardiovasc Surg,2013,145(3):730-736.
9 Marulli G,Comacchio G M,Rea F.Robotic thymectomy.J Vis Surg,2017,3(1):68.
10 Marulli G,Maessen J,Melfi F,et al.Multi-institutional European experience of robotic thymectomy for thymoma.Ann Cardiothorac Surg,2016,5(1):18-25.
11 Yoshino I,Hashizume M,Shimada M,et al.Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system.J Thorac Cardiovasc Surg,2001,122(4):783-785.
12 Hartwich J,Tyagi S,Margaron F,et al.Robot-assisted thoracoscopic thymectomy for treating myasthenia gravis in children.J Laparoendosc Adv Surg Tech A,2012,22(9):925-929.
13 丁仁泉,童向东,许世广,等.达芬奇机器人手术系统与电视电视胸腔镜在胸内纵隔疾病手术治疗中的对比研究.中国肺癌杂志,2014,7(1):557-562.
14 Ruckert J C,Swierzy M,Ismail M.Comparison of robotic and nonrobotic thoracoscopic thymectomy:a cohort study.J Thorac Cardiovasc Surg,2011,141(3):673-677.
15 Castle S L,Kernstine K H.Robotic-assisted thymectomy.Semin Thorac Cardiovasc Surg,2008,20(4):326-331.
16 Nakamura H,Suda T,Ikeda N,et al.Initial results of robot-assisted thoracoscopic surgery in Japan.Gen Thorac Cardiovasc Surg,2014,62(12):720-725.
17 Jun Y,Hao L,Demin L,et al.Da Vinci robot-assisted system for thymectomy:experience of 55 patients in China.Int J Med Robot,2014,10(3):294-299.
18 刘博,汪明敏,许世广,等.达芬奇机器人纵隔肿瘤切除术的学习曲线.中国胸心血管外科临床杂志,2017,24(1):127-131.
19 Rueckert J,Swierzy M,Badakhshi H,et al.Robotic-assisted thymectomy:surgical procedure and results.Thorac Cardiovasc Surg,2015,63(3):194-200.
20 Ye B,Tantai J C,Li W,et al.Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stage I thymoma.World J Surg Oncol,2013 11(1):157.
21 Della Marina A,Kolbel H,Mullers M,et al.Outcome after roboticassisted thymectomy in children and adolescents with acetylcholine receptor antibody-positive juvenile myasthenia gravis.Neuropediatrics,2017,48(4):315-322.
22 Straughan DM,Fontaine JP,Toloza EM.Robotic-assisted videothoracoscopic mediastinal surgery.Cancer Control,2015,22(3):326-330.
2 Friedant AJ,Handorf EA,Su S,et al.Minimally invasive versus open thymectomy for thymic malignancies:systematic review and meta-analysis.J Thorac Oncol,2016,11(1):30-38.
3 杨胜利,茹婷巧,杨劼,等.单操作孔全电视胸腔镜手术在纵隔肿物切除中的应用.华中科技大学学报(医学版),2015,44(3):330-333.
4 陈世雄,陈胜家,许家君,等.单操作孔电视胸腔镜手术治疗前纵隔肿瘤.中国胸心血管外科临床杂志,2016,23(1):634-635.
5 Bodner J,Wykypiel H,Wetscher G,et al.First experiences with the da Vinci operating robot in thoracic surgery.Eur J Cardiothorac Surg,2004,25(5):844-851.
6 Bodner J,Wykypiel H,Greiner A,et al.Early experience with robot-assisted surgery for mediastinal masses.Ann Thorac Surg,2004,78(1):259-265.
7 Augustin F,Schmid T,Bodner J.The robotic approach for mediastinal lesions.Int J Med Robot,2006,2(3):262-270.
8 Marulli G,Schiavon M,Perissinotto E,et al.Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis.J Thorac Cardiovasc Surg,2013,145(3):730-736.
9 Marulli G,Comacchio G M,Rea F.Robotic thymectomy.J Vis Surg,2017,3(1):68.
10 Marulli G,Maessen J,Melfi F,et al.Multi-institutional European experience of robotic thymectomy for thymoma.Ann Cardiothorac Surg,2016,5(1):18-25.
11 Yoshino I,Hashizume M,Shimada M,et al.Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system.J Thorac Cardiovasc Surg,2001,122(4):783-785.
12 Hartwich J,Tyagi S,Margaron F,et al.Robot-assisted thoracoscopic thymectomy for treating myasthenia gravis in children.J Laparoendosc Adv Surg Tech A,2012,22(9):925-929.
13 丁仁泉,童向东,许世广,等.达芬奇机器人手术系统与电视电视胸腔镜在胸内纵隔疾病手术治疗中的对比研究.中国肺癌杂志,2014,7(1):557-562.
14 Ruckert J C,Swierzy M,Ismail M.Comparison of robotic and nonrobotic thoracoscopic thymectomy:a cohort study.J Thorac Cardiovasc Surg,2011,141(3):673-677.
15 Castle S L,Kernstine K H.Robotic-assisted thymectomy.Semin Thorac Cardiovasc Surg,2008,20(4):326-331.
16 Nakamura H,Suda T,Ikeda N,et al.Initial results of robot-assisted thoracoscopic surgery in Japan.Gen Thorac Cardiovasc Surg,2014,62(12):720-725.
17 Jun Y,Hao L,Demin L,et al.Da Vinci robot-assisted system for thymectomy:experience of 55 patients in China.Int J Med Robot,2014,10(3):294-299.
18 刘博,汪明敏,许世广,等.达芬奇机器人纵隔肿瘤切除术的学习曲线.中国胸心血管外科临床杂志,2017,24(1):127-131.
19 Rueckert J,Swierzy M,Badakhshi H,et al.Robotic-assisted thymectomy:surgical procedure and results.Thorac Cardiovasc Surg,2015,63(3):194-200.
20 Ye B,Tantai J C,Li W,et al.Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stage I thymoma.World J Surg Oncol,2013 11(1):157.
21 Della Marina A,Kolbel H,Mullers M,et al.Outcome after roboticassisted thymectomy in children and adolescents with acetylcholine receptor antibody-positive juvenile myasthenia gravis.Neuropediatrics,2017,48(4):315-322.
22 Straughan DM,Fontaine JP,Toloza EM.Robotic-assisted videothoracoscopic mediastinal surgery.Cancer Control,2015,22(3):326-330.