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  

Perioperative outcome of robot-assisted pulmonary lobectomy in treating 333 patients with pathological stage Ⅰ non-small cell lung cancer: A single center report

作　　者：李剑涛 黄佳[1,2] 林皓 罗清泉[1,2] LI Jiantao HUANG Jia LIN Hao LUO Qingquan(Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, P.R.China School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, P,R.China)

机构地区：[1]上海交通大学附属胸科医院上海市肺部肿瘤临床医学中心,上海200030 [2]江苏大学医学院,江苏镇江212013

出　　处：《中国胸心血管外科临床杂志》2017年第11期825-829,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海申康医院发展中心新兴前沿技术联合攻关项目(SHDC12016113)

摘　　要：目的探索达芬奇机器人(da Vinci,Intuitive surgical,California,USA)辅助胸腔镜(RATS)行肺叶切除术治疗病理Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)的围术期结局。方法回顾性分析上海交通大学附属胸科医院肺部肿瘤临床中心2013年5月至2016年4月连续333例病理确诊为Ⅰ期NSCLC患者且行RATS肺叶切除术的临床资料,其中女231例(69.4%)、男102例(30.6%),年龄20~76(55.01±10.46)岁。病变位于左肺上叶37例(11.1%),左肺下叶71例(21.3%),右肺上叶105例(31.5%),右肺中叶32例(9.6%),右肺下叶88例(26.4%);其中腺癌330例(99.1%),鳞癌3例(0.9%)。结果 RATS肺叶切除手术总时间(从切皮到关胸结束)46~300(91.51±30.80)min;术中估计出血量0~100 ml 319例(95.8%),101~400 ml 12例(3.6%),>400 ml2例(0.6%);中转开胸4例(1.2%),2例因肺动脉分支出血,2例因胸腔致密粘连所致分离困难;无术后30 d内死亡病例,围术期无输血患者。患者术后第1 d胸腔引流量0~960(231.39±141.87)ml。术后留置胸腔引流管2~12(3.96±1.52)d,无带管出院患者;术后住院时间2~12(4.96±1.51)d,住院>7 d 12例(3.6%),术后漏气为主要原因,无30 d内再入院患者。所有患者均进行了淋巴结采样或淋巴结清扫术,取淋巴结2~9(5.69±1.46)组,取淋巴结个数3~21(9.80±3.43)枚。患者住院期间总费用(包含自费费用及医保覆盖费用)60 389.66~134 401.65(93 809.23±13 371.26)元。结论 RATS肺叶切除治疗病理Ⅰ期非小细胞肺癌安全、有效,可很好弥补传统胸腔镜手术的不足;相对昂贵的费用是其主要弊端。Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females （69.4%） and 102 males （30.6%） aged from 20–76 （55.01±10.46） years. Cancer was located in the left upper lobectomy in 37 （11.1%） patients, left lower lobectomy in 71 （21.3%） patients, right upper lobectomy in 105 （31.5%） patients, right middle lobectomy in 32 （9.6%） patients, right lower lobectomy in 88 （26.4%） patients. Adenocarcinoma was confirmed in 330 （99.1%） patients and squamous cell cancer was confirmed in 3 （0.9%） patients. Results Total operative time was 46–300 （91.51±30.80） min. Estimated intraoperative blood loss was 0–100 ml in 319 patients （95.8%）, 101–400 ml in 12 patients （3.6%）, 〉400 ml in 2 patients （0.6%）. Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 （231.39±141.87） ml. Chest drain time was 2–12 （3.96±1.52） d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 （4.96±1.51） d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 （5.69±1.46） groups and 3–21 （9.80±3.43） lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 （93 809.23±13 371.26） yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relati

关 键 词：DAVINCI 机器人辅助胸腔镜胸部手术(RATS) 肺叶切除术 非小细胞肺癌 围术期结局 费用 

分 类 号：R734.2[医药卫生—肿瘤]