机器人辅助解剖性肺切除的初期经验与学习曲线  被引量:4

Early experience and learning curve of anatomatic lung resection by robotic-assisted thoracoscopic surgery

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作  者:唐建[1] 喻本桐[1] 刘升[1] 许起荣[1] 袁斌[1] 刘季春[1] 

机构地区:[1]南昌大学第一附属医院心胸外科,南昌330006

出  处:《中国胸心血管外科临床杂志》2017年第7期533-537,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基  金:江西省卫生计生委科技计划(20161145)

摘  要:目的评估机器人(达芬奇系统)辅助胸腔镜解剖性肺切除手术的有效性、安全性及可行性,总结机器人手术的学习曲线。方法回顾性分析2016年3~6月,我科机器人辅助胸腔镜解剖性肺切除手术40例患者的临床资料,男29例、女11例,年龄54~78(60.2±12.7)岁;与同期行常规胸腔镜手术的37例患者[男27例、女10例,年龄52~76(58.7±11.5)岁]进行对比,分析其手术时间、术中出血量、胸腔引流时间、术后住院时间、围手术期并发症发生率及死亡率,评估其安全性及可行性,同时总结机器人手术的学习曲线。结果两组患者手术时间、术后呼吸机辅助时间、术中出血量、胸腔引流时间和术后疼痛,术后平均住院日,术后并发症发生率差异均无统计学意义。机器人辅助组术前准备时间长于胸腔镜组(24.5 min vs.15.6 min,P=0.003),机器人辅助组术中中转率低于胸腔镜组(0 vs.10.8%),两组均无围手术期死亡。结论机器人辅助胸腔镜解剖性肺切除手术在前期学习过程中安全有效,初始10例手术过后,学习曲线即可从学习阶段进入到标准阶段。Objective To summarize the surgical learning curve and evaluate the effectiveness, safety and feasibility of the robotic-assisted thoracoscopic surgery (RATS) by comparing with the conventional vedio-assisted thoracoscopic surgery (VATS). Methods The clinical data of 40 patients receiving robotic assisted thoracoscopic anatomic lung resection from March to June 2016 in our department were reviewed. There were 29 males and 11 females with the age of 54-78 (60.2±12.7) years in the RATS group, and 27 males and 10 females with the age of 52-76 (58.7±11.5) years in the VATS group. Lung space-occupying lesions were comfirmed by preoperative diagnosis. The operative time, blood loss, chest tube retention time, postoperative hospital stay and perioperative morbidity and mortality were analyzed. The safety and feasibility were evaluated, and the learning curve was summed up. Results Operative time, postoperative ventilation time, intraoperative blood loss, chest tube retention time, postoperative pain, average hospital stay, postoperative complication rate between two groups were not statistically significant. In the RATS group preoperative preparation time was longer than that of the VATS group (24.5 min vs. 15.6 min, P=0.003), and the rate of conversion to thoracotomy of the RATS group was lower than that of the VATS group (0 vs. 10.8%). There was no perioperative death in two groups. Conclusion Robotic-assisted thoracic surgery is safe and effective in the early learning process, and the learning curve can be entered into the standard stage from the learning stage after initial 10 operations.

关 键 词:解剖性肺切除 机器人辅助胸部手术 学习曲线 达芬奇手术系统 

分 类 号:R655.3[医药卫生—外科学]

 

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