基于倾向性评分匹配法的机器人与胸腔镜辅助胸外科手术治疗肺癌的近期效果比较

目的在倾向性评分匹配配对良好的情况下，比较机器人与胸腔镜在肺癌手术治疗中的围手术期安全性与短期疗效。 方法回顾性分析2020年8月至2020年10月期间，山东大学齐鲁医院胸外科田辉教授肺外科团队因原发性肺癌行肺叶或亚肺叶切除+肺门纵隔淋巴结清扫或采样术的286例患者的临床资料。其中，130例行达芬奇机器人辅助胸外科（RATS）肺切除术，为RATS组；156例行电视胸腔镜辅助胸外科（VATS）肺切除术，为VATS组。采用倾向性评分匹配方法进行混杂因素校正，比较匹配后两组病例的围手术期结果。 结果倾向性评分匹配分析后，每组88例配对成功。对两组病例的围手术期临床资料行统计学分析，发现RATS组手术时间略长于VATS组，但差异无统计学意义(P＝0.625)。RATS组术中出血量较VATS组更少（P<0.001）。RATS组淋巴结清扫站数（P<0.001）及清扫个数（P＝0.031）均高于VATS组；RATS组住院费用较VATS组高，差异有统计学意义（P<0.001）。术后第1~3天疼痛数字评分（NRS评分）差异有统计学意义（P<0.001），RATS组术后第1~3天NRS评分更高。两组淋巴结升期率、术后第1~3天引流量、术后全部拔管时间、术后住院天数、术后并发症差异无统计学意义（P>0.05）。 结论在可切除肺癌手术治疗上，RATS与VATS的围手术期安全性及短期疗效相似。此外，RATS在术中出血量、淋巴结清扫彻底性上存在优势，缺点是增加了住院总费用，潜在增加了术后疼痛。

Comparison of short-term outcomes between robot-assisted thoracic surgery and video-assisted thoracoscopic surgery on lung cancer: a study based on propensity score matching

ObjectiveTo compare the perioperative safety and short-term efficacy between robot- and video-assisted thoracoscopic lung cancer surgery based on propensity scores matching. MethodsThe clinical data were from 286 patients with primary lung cancer undergoing lobectomy or sublobectomy and lymph node dissection or sampling in the Department of Thoracic Surgery, Qilu Hospital of Shandong University from August 2020 to October 2020. Among them, 130 cases underwent Da Vinci robot-assisted thoracic surgery (RATS) , while 156 cases underwent video-assisted thoracic surgery (VATS) . The perioperative data were compared after controlling confounding factors by propensity score matching. ResultsEighty-eight cases in each group were successfully matched by propensity score matching analysis. The operational time of the RATS group was slightly longer than that of the VATS group , the difference was not statistically significant (P=0.625) . The intraoperative blood loss in the RATS group was less than that in the VATS group (P<0.001) . The number of lymph node dissection stations (P<0.001) and the number of lymph node dissections (P=0.031) in the RATS group were higher. In terms of hospitalization expenses, the RATS group was higher than that compared with the VATS group (P<0.001) . There was a statistically significant difference in the results of the NRS score after operation (P<0.001) , and the NRS score was higher. There were no statistically significant differences in lymph node ascending rate, time of drainage, drainage, hospital stay after operation, and postoperative complications (P>0.05) . ConclusionRATS has similar perioperative safety and short-term efficacy to VATS in resectable lung cancer. RATS has advantages in intraoperative blood loss and lymph node dissection. The disadvantage is the increased hospitalization cost and postoperative pain.