机器人与电视胸腔镜手术治疗纵隔支气管源性囊肿的对比研究  

A Comparison Between da Vinci S Surgical System and VATS for Mediastinal Bronchogenic Cysts

作　　者：许世广[1] 王希龙[1] 童向东[1] 刘博[1] 徐惟[1] 李博[1] 王通[1] 刘星池[1] 滕洪[1] 高昕[1] 王述民[1] 

机构地区：[1]沈阳军区总医院胸外科,沈阳110016

出　　处：《中国微创外科杂志》2015年第3期193-196,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结应用达芬奇机器人手术系统行纵隔支气管源性囊肿切除手术的经验。方法回顾性分析我科2009年7月-2013年9月25例手术治疗并经术后病理证实为支气管源性囊肿的临床资料,其中应用电视胸腔镜手术切除9例（2011年3月前）,应用达芬奇机器人手术系统切除16例（2011年3月后）,对手术时间、术中出血量、术后拔管时间、术后住院时间等进行比较。结果胸腔镜组1例术中见囊肿与右主支气管形成瘘口,行瘘口修补,术后发生脓胸,再次行脓胸清除术后恢复良好;机器人组1例术中见囊肿与食管关系密切,在胃镜辅助下行囊肿大部切除。其余病例均顺利完成手术。2组手术时间差异无显著性[机器人组（84.1±37.6）min,胸腔镜组（128.8±73.4）min,t=-2.031,P=0.054],术中出血量、术后引流时间、术后住院时间机器人组均小于胸腔镜组[出血量：中位数5 ml（0-50 ml）vs.20 ml（0-600 ml）,Z=-2.169,P=0.030;术后引流时间：2 d（1-8 d）vs.5 d（1-12 d）,Z=-2.285,P=0.022）;术后住院时间：（5.8±2.4）d vs.（11.0±6.3）d,t=-3.003,P=0.006]。术后随访机器人组1-20个月[（12.1±6.8）月],胸腔镜组24-51个月[（36.1±9.5）月],均恢复良好,无复发。结论与胸腔镜手术相比,应用达芬奇机器人手术系统治疗纵隔支气管源性囊肿,具有安全、术中出血量少、术后引流时间和住院时间短等优势。Objective To summarize the experience of surgical treatment for mediastinal bronchogenic cysts with the da Vinci S Surgical System. Methods A total of 25 patients with bronchogenic cysts underwent surgical treatment from July 2009 to September 2013,9 of which received VATS（ befor March 2011） and 16 of which received operation with the da Vinci S Surgical System（ after March 2011）. Clinical data were collected about operating time,blood loss,time of drainage,and postoperative hospital stay. Results Empyema occurred in 1 case in the VATS group because of a fistula between the cyst and the right main bronchus. A second operation was given with good recovery. In the robot group,gastroscopy was required in 1 case because of adhesion of cyst to the esophagus. The other surgical processes were completed successfully. There was no significant difference between the robot group and the VATS group in the operation time [（ 84. 1 ± 37. 6） min vs.（ 128. 8 ± 73. 4） min,t =- 2. 031,P = 0. 054]. As compared with the VATS group,the robot group had significantly less blood loss [5（ 0- 50） ml vs. 20（ 0- 600） ml,Z =- 2. 169,P = 0. 030],shorter time of drainage [1- 8 days（ median,2 d） vs. 1- 12 days（ median,5 d）,Z =- 2. 285,P = 0. 022 ],and shorter postoperative hospital stay [（ 5. 8 ± 2. 4） days vs.（ 11. 0 ± 6. 3） days,t =- 3. 003,P = 0. 006]. Follow-ups after operation were conducted for 1- 20 months（ 12. 1 ± 6. 8 months） in the robot group and 24- 51 months（ 36. 1 ± 9. 5 months） in the VATS group.No recurrence was found. Conclusion As compared to VATS,the da Vinci S Surgical System can be safely used for the treatment of mediastinal bronchogenic cysts,with shorter operating time,less blood loss,shorter time of drainage and postoperative hospital stay.

关 键 词：支气管源性囊肿 微创外科手术 机器人 达芬奇手术系统 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R655[自动化与计算机技术—控制科学与工程]