58例达芬奇机器人系统辅助肺部手术的临床分析
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摘要
目的探讨及总结采用达芬奇机器人系统行肺部手术的初期经验。方法回顾性收集西安交通大学第一附属医院胸外科行达芬奇机器人手术系统辅助肺部手术病例的临床资料并进行统计分析。结果 2016年3月-2017年11月我院应用达芬奇机器人系统行肺部手术58例,其中男42例,女16例,年龄25～79(59±11)岁。所有病例均顺利完成机器人手术,包括肺叶切除41例,肺段切除7例,肺楔形切除6例,肺袖式切除2例,联合肺段切除、楔形+肺段各1例;术后病理诊断为良性病变17例,肺癌41例;手术时间分别为,肺叶切除(169.93±66.88)min,肺段切除(165.43±56.37)min;术中清扫淋巴结5～26(15.1±8.7)枚;术后留置胸腔引流管2～15(6.0±2.6)d,术后住院时间2～21(7.95±3.23)d。除1例患者出现支气管胸膜瘘接受二次手术外,余均无严重术后并发症,顺利出院。患者住院期间总费用为32 015.57～127 087.89(78 483.19±15 925.18)元。结论达芬奇机器人系统辅助肺部手术在具有丰富常规胸腔镜手术经验的医疗中心可顺利开展,其效果安全、可行,并且在一些复杂操作中具有优势,但是相对昂贵的费用是限制其使用的一个重要因素。
Objective To explore the safety, feasibility and clinical value of Da Vinci robot system-assisted pulmonary surgery. Methods The clinical data of Da Vinci robot system-assisted pulmonary surgery in our department were collected retrospectively and analyzed. Results From March 2016 to November 2017, we enrolled 58 patients(42 males and 16 females, mean age 59±11 years) for the robotic system-assisted pulmonary surgery at our hospital. All surgeries were successfully completed, which consisted of lobectomy in 41 cases, segmentectomy in 7 cases, pulmonary wedge-shaped resection in 6 cases, pulmonary sleeve resection in 2 cases, combined resection in 1 case, and wedge-shaped resection & segmentectomy in 1 case. The postoperative diagnosis was benign lesions in 17 cases, and lung cancer in 41 cases. The average operation time was 169.93±66.88 mins for lobectomy and 165.43±56.37 mins for segmentectomy. The lymph node resection ranged from 5 to 26 pieces(mean of 15.1±8.7 pieces). The postoperative drainage time ranged from 2 to 15 days(mean of 6.0±2.6 days) and hospitalization time was 2 to 21 days(mean of 7.95±3.23 days). All but one patient recovered smoothly and were discharged with the total cost ranging from 32 015.57 to 127 087.89 yuan(mean of 78 483.19±15 925.18 yuan). The patient with bronchopleural fistula after resection was successfully treated with lobectomy. Conclusion Da Vinci robotic system-assisted pulmonary surgery can be performed successfully in a center with extensive experience in thoracoscopic surgery. It is safe, feasible and advantageous in some complex operations, but the relatively expensive cost is an important factor that affects its wide application.
Objective To explore the safety, feasibility and clinical value of Da Vinci robot system-assisted pulmonary surgery. Methods The clinical data of Da Vinci robot system-assisted pulmonary surgery in our department were collected retrospectively and analyzed. Results From March 2016 to November 2017, we enrolled 58 patients(42 males and 16 females, mean age 59±11 years) for the robotic system-assisted pulmonary surgery at our hospital. All surgeries were successfully completed, which consisted of lobectomy in 41 cases, segmentectomy in 7 cases, pulmonary wedge-shaped resection in 6 cases, pulmonary sleeve resection in 2 cases, combined resection in 1 case, and wedge-shaped resection & segmentectomy in 1 case. The postoperative diagnosis was benign lesions in 17 cases, and lung cancer in 41 cases. The average operation time was 169.93±66.88 mins for lobectomy and 165.43±56.37 mins for segmentectomy. The lymph node resection ranged from 5 to 26 pieces(mean of 15.1±8.7 pieces). The postoperative drainage time ranged from 2 to 15 days(mean of 6.0±2.6 days) and hospitalization time was 2 to 21 days(mean of 7.95±3.23 days). All but one patient recovered smoothly and were discharged with the total cost ranging from 32 015.57 to 127 087.89 yuan(mean of 78 483.19±15 925.18 yuan). The patient with bronchopleural fistula after resection was successfully treated with lobectomy. Conclusion Da Vinci robotic system-assisted pulmonary surgery can be performed successfully in a center with extensive experience in thoracoscopic surgery. It is safe, feasible and advantageous in some complex operations, but the relatively expensive cost is an important factor that affects its wide application.
引文
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[3] 李剑涛,黄佳,林皓,等.单中心连续333例机器人辅助胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌[J].中国胸心血管外科临床杂志,2017,24(11):825-829.
[4] LIANG H,LIANG W,ZHAO L,et al.Robotic versus video-assisted lobectomy/segmentectomy for lung cancer:A meta-analysis[J].Ann Surg,2018,268(2):254-259.
[5] CERFOLIO RJ,BRYANT AS,SKYLIZARD L,et al.Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms[J].J Thorac Cardiovasc Surg,2011,142(4):740-746.
[6] 许世广,刘星池,王希龙,等.应用达芬奇机器人手术系统肺切除技术总结[J].中华胸部外科电子杂志,2016,3(2):77-82.
[7] YAN TD.Surgical atlas of thoracoscopic lobectomy and segmentectomy[J].Ann Cardiothorac Surg,2014,3(2):183-191.
[8] 唐建,喻本桐,刘升,等.机器人辅助解剖性肺切除的初期经验与学习曲线[J].中国胸心血管外科临床杂志,2017,24(7):533-537.
[9] TOKER A,OZYURTKAN MO,KABA E,et al.Robotic anatomic lung resections:The initial experience and description of learning in 102 cases[J].Surg Endosc,2016,30(2):676-683.
[2] 喻本桐,唐建.达芬奇机器人系统在胸外科手术中的应用[J].中国医师杂志,2017,19(7):961-965.
[3] 李剑涛,黄佳,林皓,等.单中心连续333例机器人辅助胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌[J].中国胸心血管外科临床杂志,2017,24(11):825-829.
[4] LIANG H,LIANG W,ZHAO L,et al.Robotic versus video-assisted lobectomy/segmentectomy for lung cancer:A meta-analysis[J].Ann Surg,2018,268(2):254-259.
[5] CERFOLIO RJ,BRYANT AS,SKYLIZARD L,et al.Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms[J].J Thorac Cardiovasc Surg,2011,142(4):740-746.
[6] 许世广,刘星池,王希龙,等.应用达芬奇机器人手术系统肺切除技术总结[J].中华胸部外科电子杂志,2016,3(2):77-82.
[7] YAN TD.Surgical atlas of thoracoscopic lobectomy and segmentectomy[J].Ann Cardiothorac Surg,2014,3(2):183-191.
[8] 唐建,喻本桐,刘升,等.机器人辅助解剖性肺切除的初期经验与学习曲线[J].中国胸心血管外科临床杂志,2017,24(7):533-537.
[9] TOKER A,OZYURTKAN MO,KABA E,et al.Robotic anatomic lung resections:The initial experience and description of learning in 102 cases[J].Surg Endosc,2016,30(2):676-683.
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