达芬奇机器人与胸腔镜下纵隔肿瘤切除术的回顾性队列研究

目的总结本中心微创纵隔肿瘤切除术的经验,比较达芬奇机器人与胸腔镜手术治疗纵隔肿瘤的优劣。方法采用回顾性队列研究的方法,连续性纳入2014年9月至2019年11月我科单个医疗组行微创前纵隔肿瘤切除术的102例患者。根据手术方式将患者分为两组:机器人组(n=47,男23例、女24例,平均年龄52岁)和胸腔镜组(n=55,男29例、女26例,平均年龄53岁)。比较分析各组患者的手术时间、术中出血量、术后胸腔引流量、术后胸腔引流时间、术后住院时间、住院费用等临床资料。结果两组患者均顺利完成手术,无围术期死亡等严重并发症,顺利康复出院。机器人组4例患有重症肌无力;胸腔镜组中5例患有重症肌无力。肿瘤大小:机器人组2.5(0.8~8.7)cm,胸腔镜组3.0(0.8~7.7)cm;手术时间:机器人组62(30~132)min,胸腔镜组60(29~118)min;术中出血量:机器人组20(2~50)mL,胸腔镜组20(5~100)mL;术后胸腔引流量:机器人组240(20~14130)mL,胸腔镜组295(20~1070)mL;术后胸腔引流时间:机器人组2(1~15)d,胸腔镜组2(1~5)d;以上指标两组间差异无统计学意义(P>0.05)。术后住院时间:机器人组3(2~18)d,胸腔镜组4(2~14)d,差异有统计学意义(P=0.014);住院费用:机器人组为67489(26486~89570)元,胸腔镜组27917(16817~67603)元,差异具有统计学意义(P=0.000)。结论达芬奇机器人手术与电视胸腔镜手术在治疗前纵隔肿瘤上,疗效和安全性相当,住院时间更短,但费用较高。

Da Vinci robot-assisted surgery versus video-assisted thoracoscopic surgery for resection of mediastinal tumors:A retrospective cohort study

Objective To summarize the experience of minimally invasive anterior mediastinal tumor resection in our center,and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor.Methods A retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department.They were divided into two groups:a robotic group(n=47,23 males and 24 females,average age of 52 years)and a thoracoscopic group(n=55,29 males and 26 females,average age of 53 years).The operation time,intraoperative blood loss,postoperative thoracic drainage volume,postoperative thoracic drainage time,postoperative hospital stay,hospitalization expense and other clinical data of two groups were compared and analyzed.Results All the patients successfully completed the surgery and recovered from hospital,with no perioperative death.Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group.The tumor size was 2.5(0.8-8.7)cm in the robotic group and 3.0(0.8-7.7)cm in the thoracoscopic group.Operation time was 62(30-132)min in the robotic group and 60(29-118)min in the thoracoscopic group.Intraoperative bleeding volume was 20(2-50)mL in the robotic group and 20(5-100)mL in the thoracoscopic group.The postoperative drainage volume was 240(20-14130)mL in the robotic group and 295(20-1070)mL in the thoracoscopic group.The postoperative drainage time was 2(1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the twogroups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18)days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489(26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000).Conclusion Compared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the sameefficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.