胸腺切除术中达芬奇机器人与传统手术对比分析

目的 研究分析采用达芬奇机器人手术、胸腔镜手术和开胸手术三种不同手术方式进行胸腺切除术的临床资料,探讨机器人手术对治疗胸腺病变的临床应用价值.方法 回顾性分析2009年1月至2013年8月我院进行手术切除的136例胸腺病变的临床资料,其中采用达芬奇机器人手术43例,胸腔镜手术49例,正中胸骨切开手术44例.收集记录三种不同手术方式病例的临床一般性资料,术中以及术后恢复情况资料进行比较分析.结果 全组患者均手术成功,三组患者的术前临床资料无统计学差异,达芬奇机器人手术和胸腔镜手术组,在手术时间、术中出血量、术后24 h胸引量、术后ICU及住院天数方面明显优于开胸手术组（P＜0.05）.达芬奇机器人手术同胸腔镜手术比较,平均术中出血量（78±21mlvs 126±29 ml）、术后胸引天数（1.9±0.7vs2.5± 1.1）d以及术中中转开胸率（0/43 vs 3/49）方面,前者明显优于后者,P＜ 0.05.两组手术时间、术后住院时间无明显差异.结论应用机器人及胸腔镜的微创手术较开胸手术创伤小,术后恢复快.达芬奇机器人手术系统在胸腺切除手术中可取得和胸腔镜手术相似的治疗效果,但在术中操作和安全性上更有的优势.

Clinical analysis of thymectomy with Da Vinci robotic-assisted surgical system comparing to that with video-assisted thoracoscopic surgery and via median sternotomy approach for thymic disease

Objective To study the clinical data of thymectomy by three different surgical methods： robotic-assisted thoracoseopic surgery（RATS）, video-assisted thoracoseopic surgery（VATS） and median sternotomy approach（MS）, and assess the clinical application value of RATS. Methods From Jan 2009 and Aug 2013, 136 patients with thymic disease received surgical treatment, Among them, the cases received RATS, VATS and MS were 43, 49, and 44, respectively. Clinical data of patients＇ periopertative characteristics were collected and analyzed retrospectively. Results All patients were received successful surgical procedure. Preoperative general features for the patients in three groups showed no statistic difference. Outcomes of intraoperative blood loss volumes, postoperative pleural drainage volume, the duration of operation, the postoperative ICU and hospital stay in the RATS and VATS groups were significantly less or shorter than MS group. 3 patients needed conversion to open surgery in VATS group （3/49） while no patient in RATS group （0/43）. Intraoperative blood loss volumes and period of pleuraldrainage was much less or shorter in RATS group compared with VATS group （78± 21 ml vs 126 ± 29 ml, 1.9± 0.7 d vs 2.5±1.1）. No significant difference between the VATS and RATS groups was observed in operation time and hospital stay. Conclusion The benefits of RATS and VATS were less traumatic and better for recoverys versus tranditional MS. Da vincic robotic-assisted surgical system for thymectomy resulted in similar effect of surgical treatment compared with VATS , while it may be more safe and easier for operating.