达芬奇机器人与电视胸腔镜肺癌根治术后乳糜胸危险因素的倾向性评分匹配研究  

Risk factors for postoperative chylothorax after robot-assisted versus video-assisted thoracic surgery in radical lung cancer resection:A propensity score matching study

作　　者：刘德宇 许世广 徐惟 刘博 李博 王希龙 胡博潇 王仕祺 修语池 王述民 LIU Deyu;XU Shiguang;XU Wei;LIU Bo;LI Bo;WANG Xilong;HU Boxiao;WANG Shiqi;XIU Yuchi;WANG Shumin(Graduate Training Base of General Hospital of Northern Theater Command,China Medical Univercity,Shenyang,110016,P.R.China;Department of Thoracic Surgery,General Hospital of Northern Theater Command,Shenyang,110016,P.R.China)

机构地区：[1]中国医科大学北部战区总医院研究生培养基地,沈阳110016 [2]北部战区总医院胸外科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2022年第4期449-456,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对比机器人辅助胸外科手术(robot-assisted thoracic surgery,RATS)和电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)术后乳糜胸发生率的差异,分析微创肺癌根治术后乳糜胸的危险因素,探讨相应处理及防治办法。方法纳入2012年6月—2020年9月于北部战区总医院行微创肺癌根治术的1083例肺癌患者,其中男578例、女505例,平均年龄(60.6±9.4)岁。根据手术方式分为两组:RATS组(499例)与VATS组(584例)。倾向性评分匹配后两组各434例。分析比较两组乳糜胸发生率及围手术期相关指标差异,并针对术后乳糜胸进行单因素分析和多因素logistic回归分析。结果共有24例患者出现术后乳糜胸。与VATS组相比,RATS组乳糜胸发生率更高(3.9%vs.1.6%,P=0.038),清扫淋巴结组数和个数更多(P均<0.001),术中出血量更少(P<0.001)。两组术后住院时间(P=0.256)和带管时间(P=0.504)差异无统计学意义。单因素分析显示,性别(P=0.021)、吸烟史(P=0.001)、手术方式(P=0.045)、清扫淋巴结组数(P<0.001)是术后乳糜胸的影响因素。多因素logistic回归分析显示吸烟史[OR=4.344,95%CI(1.149,16.417),P=0.030]、清扫淋巴结组数[OR=1.680,95%CI(1.221,2.311),P=0.001]是术后乳糜胸的独立危险因素。结论RATS相比VATS术后乳糜胸发生率略高,但RATS清扫淋巴结更彻底,术中出血量更少。术前有吸烟史、术中清扫淋巴结组数更多的患者术后更易出现乳糜胸。Objective To compare the postoperative chylothorax outcomes of robot-assisted thoracic surgery(RATS)and video-assisted thoracoscopic surgery(VATS),analyze the risk factors for postoperative chylothorax after minimally invasive radical lung cancer resection and explore possible prevention and control measures.Methods Between June 2012 and September 2020,1083 patients underwent minimally invasive pulmonary lobectomy and systematic lymph node dissection in our hospital,including 578 males and 505 females with an average age of 60.6±9.4 years.Patients were divided into two groups according to the operation methods:a RATS group(499 patients)and a VATS group(584patients).After propensity score matching,434 patients were included in each group(868 patients in total).Chylothorax and other perioperative indicators were compared between the two groups.Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chylothorax.Results Overall,24 patients were diagnosed with chylothorax after surgery.Compared with the VATS group,the rate of chylothorax was higher(3.9%vs.1.6%,P=0.038),the groups and numbers of dissected lymph nodes were more(both P<0.001),and the intraoperative blood loss was significantly less(P<0.001)in the RATS group.There was no statistical difference in the postoperative hospital stay(P=0.256)or chest tube drainage time(P=0.504)between the two groups.Univariate analysis showed that gender(P=0.021),operation approach(P=0.045),smoking(P=0.001)and the groups of dissected lymph nodes(P<0.001)were significantly associated with the development of chylothorax.Multivariate analysis showed that smoking[OR=4.344,95%CI(1.149,16.417),P=0.030]and the groups of dissected lymph nodes[OR=1.680,95%CI(1.221,2.311),P=0.001]were the independent risk factors for postoperative chylothorax.Conclusion Compared with the VATS,the rate of chylothorax after RATS is higher with more dissected lymph nodes and less blood loss.The incidence of chylothorax after minimally invasive radi

关 键 词：机器人辅助胸外科手术 电视辅助胸腔镜手术 术后乳糜胸 肺癌根治术 系统性淋巴结清扫 倾向性评分匹配研究 

分 类 号：R734.2[医药卫生—肿瘤]