机器人肺叶袖式切除成形及支气管成形术的可行性及质量控制

目的探讨机器人肺叶袖式切除成形及支气管成形术的可行性,并总结其质量控制及技术流程管理体会。方法2018年1~12月我院共完成机器人肺叶袖式切除成形及支气管成形手术5例,其中男3例、女2例,年龄56.6(39~75)岁。右肺上叶2例,右肺中叶1例,左肺下叶2例。手术入路同机器人肺叶切除术的手术切口。术中首先充分游离叶裂,清扫所有纵隔肿大淋巴结,解剖肺门,裸化肺动静脉血管和支气管,处理肺血管,显露主支气管后,在病变远端切断支气管,袖式切除病变所在肺叶(含病变),切除近远端支气管均送术中快速冰冻病理检查并证实支气管切缘阴性后,以3-0 Prolene线自后壁连续缝合吻合支气管,吻合结束后膨肺试验无漏气,吻合口不再做包裹。结果手术时间147.4(100~192)min,其中支气管吻合时间17.6(14~25)min,术中出血量60.0(20~100)mL,清扫淋巴结数量20(9~37)枚;病理类型:鳞癌3例,腺癌1例,神经内分泌肿瘤1例,所有患者术中支气管残端冰冻病理结果均为阴性。5例患者术后均恢复良好,未出现围术期并发症,吻合口通畅。术后住院时间为10.8(7~14)d。随访6~12个月,未出现吻合口狭窄及其他手术相关并发症。结论由于机器人系统为三维立体视野且具有7个自由度的活动关节的专用器械,机器人下行支气管缝合更加灵活、确切,所以机器人下行肺叶袖式切除成形及支气管成形手术是安全、可行的。

Feasibility and quality control of robotic sleeve lobectomy and bronchoplasty

Objective To explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management.Methods From January to December 2018,our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients,including the upper right lung lobe in 2 patients,the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients.There were 3 males and 2 females with an age of 56.6(39-75)years.The surgical approach was the same as the surgical incision of the robotic lobectomy.During the operation,the lobes were separated,all enlarged mediastinal lymph nodes were cleaned,pulmonary hilum was dissected,pulmonary arteriovenous vessels and bronchi were exposed,and pulmonary vessels were treated.After exposing the main bronchi,the bronchi were cut off at the distal end of the lesion,and the lobes where the lesion was located(including lesions)were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis.After the anastomosis,no air leakage was found in the expanded lung,and the anastomosis was no longer wrapped.Results The operation time was 147.4(100-192)min,including bronchial anastomosis time 17.6(14-25)min.Intraoperative blood loss was 60.0(20-100)mL,and 20(9-37)lymph nodes were dissected.Three patients had squamous cell carcinoma,1 adenocarcinoma,and 1 neuroendocrine tumor.All patients showed negative results in the freezing pathology of bronchial stump during operation.All patients recovered well after surgery,without perioperative complications,and the anastomosis was smooth.Postoperative hospital stay was 10.8(7-14)days.The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications. Conclusion Since the robot system is aspecial instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is moreflexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.