达芬奇机器人手术与胸腔镜辅助小切口手术对肺手术患者创伤对比分析  

A Comparative Study about Trauma after Da Vinci Robotic Surgery and Video- Assisted Mini-Thoractomy

作　　者：张大坤[1] 许世广[2] 丁仁泉[1] 王述民[2] 

机构地区：[1]辽宁医学院,辽宁锦州121000 [2]沈阳军区总医院,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2014年第5期296-300,共5页Trauma and Critical Care Medicine

摘　　要：目的对比达芬奇机器人手术与胸腔镜辅助小切口手术两种术式对肺手术患者的创伤因素,评价达芬奇机器人手术微创效果。方法选取40例行达芬奇手术的患者和48例行胸腔辅助小切口手术患者。达芬奇机器人手术组采用三臂法,即一个镜头臂,两个操作臂,使用达芬奇机器人专用戳卡,同时另作一个3~4 cm的辅助操作口,使用切口保护套撑开保护切口;胸腔镜辅助小切口手术组于第7肋间打进镜口,另于腋下行7~12 cm小切口,用肋骨撑开器撑开肋骨完成手术,术后常规留置1或2枚胸腔引流管。记录术中出血、术后疼痛程度（疼痛调查法,The McGill Pain Questionnaire,MPQ）、术后引流量、术后留置引流管时间,对比分析两组治疗结果。结果两组88例手术均顺利完成。术中出血量：达芬奇机器人手术组（49±14）ml,胸腔镜辅助小切口手术组（197±34）ml;疼痛评分：达芬奇机器人手术组总评级疼痛分级指数（PRI）平均为0.1523±0.0229,胸腔镜辅助小切口手术组疼痛总评级指数PRI平均为0.2571±0.0345;术后总胸腔引流量：达芬奇机器人手术组为（874±139）ml,留置时间为（6±1）d;胸腔镜辅助小切口手术组术后总胸腔引流量为（1696±201）ml,平均留置时间为（8±1）d。采用t检验统计分析上述4组数据,均P〈0.05,差异有统计学意义。结论相对于胸腔镜辅助小切口手术,达芬奇机器人手术能够减轻手术对患者造成的疼痛,同时能够减少术中术后出血,减少术后引流和带管时间,所以更加安全、微创。Objective To compare the parameters of trauma after da Vinci robotic surgery and video - assisted mini - thoractomy （VAMT） and evaluate the minimally invasion of da Vinci robotic system. Methods We collected 40 patients that underwent da Vinci robotic surgery and 48 patients that underwent video - assisted mini - thoractomy. We used 3 arms, one endoscopic pole and two operating poles ,for robotic procedures and a 3 -4 cm auxiliary incision was needed for lung resection. In VAMT,the endoscopic pole was placed in the 7th intercostals space. A 7 - 12 cm incision was made for performance and a rib retractor was needed. We collected the data about blood loss, degree of postoperative pain, volume and duration of drainage and compared it between the two groups. Results All of the 88 cases completed operation smoothly. The blood loss was （49 ± 14） ml in robot group VS （ 197 ± 34） ml in VAMT group ; the pain scale was PRI O. 1523 ± 0. 0229 in robot group VS PRI 0. 2571 ±0. 0345 in VAMT group;the postoperative drainage was （874 ± 139） ml for（6 ± 1 ） d in robot group VS （ 1696 ± 201 ） ml for （8 ± 1 ） d. The results were applied t - test to perform statistical analysis, P 〈 0.05. Conclu- sion With robotic surgery, the pain and blood loss is less than that with VAMT, and the volume and time of drainage is al- so less. The robotic surgery is safer and minimally invasive.

关 键 词：达芬奇机器人手术 胸腔辅助小切口手术 出血 疼痛评分 McGill疼痛调查表 微创 

分 类 号：R655[医药卫生—外科学]