应用达芬奇机器人手术系统肺切除技术总结

目的总结应用达芬奇机器人手术系统进行肺切除手术的经验和教训。 方法回顾性分析2012年3月至2015年11月沈阳军区总医院胸外科应用达芬奇机器人手术系统对206例肺癌患者进行肺切除手术的临床资料，其中男性120例，女性86例；平均年龄61岁。按年度分别统计，分析机器人肺叶切除的学习曲线。 结果206例肺癌患者均应用达芬奇机器人完成肺叶切除(或联合肺叶切除)和淋巴结清除术，其中右肺上叶切除58例，右肺下叶切除48例，右肺中叶切除11例，左肺上叶切除35例，左肺下叶切除53例，另有1例同期行左肺上叶病灶切除和右肺上叶切除；所有患者行系统淋巴结清除术。其中3例因肺动脉出血辅助小切口行肺动脉修补，无中转开胸病例。术后病理检查显示腺癌157例(双肺同期手术患者双侧均为腺癌)，鳞癌17例，腺鳞癌19例，小细胞癌7例，其他6例。无围手术期死亡病例。 结论应用达芬奇机器人手术系统行肺切除手术总体安全有效，稳定和配合默契的手术团队有助于手术安全和效率的提高。

Experience in lobectomy with Da Vinci robotic surgical system

ObjectiveTo summarize the experience in lobectomy with Da Vinci robotic surgical system. MethodsThe clinicaldataof 206 patients with lung cancer undergoing lobectomy with Da Vinci robotic surgical system between March 2012 and November 2015 in Department of Thoracic Surgery, General Hospital of Shenyang Military Area Command were retrospectively analyzed. Among these patients, 120 were males and 86 were females, and the mean age was 61 years. The data were statistically explored by year, and the learning curve of robotic lobectomy was analyzed. ResultsAll cases completed lobectomy and lymph node dissection with Da Vinci robotic surgical system. Among the 206 cases, there were right upper lobectomy in 58 cases, right lower lobectomy in 48 cases, right medium lobectomy in 11 cases, left upper lobectomy in 35 cases, left lower lobectomy in 53 cases, and both left upper lesion resection and right upper lobectomy in the other case. Three cases performed an additional small incision to repair the ruptured pulmonary artery. There was no transfer to open chest surgery. The postoperative pathological examinationindicated there were 157 cases of adenocarcinoma(including both sides of the case undergoing both left upper lesion resection and right upper lobectomy), 17 cases of squamous cell carcinoma, 19 cases of adenosquamous carcinoma, 7 cases of small cell lung cancer, and 6 cases of other findings. There was no perioperative death. ConclusionLobectomy with Da Vinci robotic surgical system is safe and effective, and a good teamwork can lead to a better result.