达芬奇机器人辅助胸腺切除术的早期应用体会  

The early experience of robot-assisted thymectomy

作　　者：陶绍霖[1] 康珀铭[1] 蒋彬[1] 沈诚[1] 邓波[1] 王如文[1] 周景海[1] 谭群友[1] 

机构地区：[1]第三军医大学大坪医院全军胸外科研究所,重庆400042

出　　处：《中国医师杂志》2017年第7期966-969,共4页Journal of Chinese Physician

摘　　要：目的总结达芬奇机器人系统行胸腺切除术的早期经验，探讨其临床应用价值和关键技术细节。方法2016年10月至2017年5月应用达芬奇机器人系统行胸腺切除术16例，胸腺增生10例，胸腺瘤5例，胸腺小细胞癌1例。其中伴有重症肌无力（MG）11例，Osserman分型Ⅰ型5例，ⅡA型3例，ⅡB型2例，Ⅲ型1例。分析其手术方法及术后疗效。结果所有病例均成功完成手术，无中转、围手术期死亡。经右胸入路7例，剑突下入路9例，Docking时间2～45（11．69±11．03）min；机器人操作时间47～152（84．06±25．67）min；术中出血量0～150（57．50±37．32）ml，切除胸腺及肿瘤直径4～19．5cm及（8．22±3．64）cm。术后14例当日拔除气管插管，2例分别于术后第6天和第8天拔除。术后1例出现肌无力危象，再次气管插管，经调整嗅吡斯的明用量，激素冲击等治疗后出院。术后随访2—7个月，无失访病例，症状无复发或加重。结论应用达芬奇机器人系统能够精准、稳定、安全地完成胸腺及胸腺瘤扩大切除、前纵隔脂肪清扫术，值得临床推广应用。Objective To summarize the early experience of thymectomy by robot-assisted thoraco- scopic surgery （RATS） with the da Vinci S Surgical System. Methods A total of 16 patients was under-went thymectomy from October 2016 to May 2017 by RATS. Among them, there were 10 cases of thymic hy-perplasia, 5 cases of thymoma and 1 case of thymic small cell carcinoma, including 11 cases of myasthenia gravis （MG）. The Osserman types were as follows： type Ⅰ（5）, type ⅡA （3）, type lIB （2）, and type Ⅲ（ 1 ）. Clinical data were collected and analyzed. Results The operations were successfully accomplished by RATS in all the 16 patients without any conversion to open surgery and major complication. The docking time was 2 - 45 （ 11.69±11.03 ） rain. The operation time was 47 - 152 （84. 06±25.67） rain. The blood loss was 0 - 150 （ 57.50±37.32） ml. The diameter of thymus or tumor was 4 - 19.5 cm and （ 8. 22±3.64） cm. Fourteen cases were removed tracheal intubation in the operation day, and the other 2 cases taked off in 6th and 8th days. One case occurred myasthenia gravis crisis after surgery. All patients were followed up for 2 - 7 months after discharge without MG recurrence. Conclusions The da Vinci S Surgical System can be safely, accurately and stably used for thymectomy.

关 键 词：机器人 胸腺切除术 

分 类 号：R655.7[医药卫生—外科学] R736.3[医药卫生—临床医学]