达芬奇机器人系统辅助解剖性肺段切除的初期经验  

Early experience of anatomic segmentectomy by robotic-assisted thoracoscopic surgery

作　　者：唐政 刘俊[1] 胡卫东[1] Tang Zheng;Liu Jun;Hu Weidong(Department of Thoracic Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院胸外科,武汉430071

出　　处：《中华实验外科杂志》2023年第11期2363-2365,共3页Chinese Journal of Experimental Surgery

摘　　要：目的:探讨达芬奇机器人系统(RATS)辅助解剖性肺段切除术的初期经验。方法:回顾性分析武汉大学中南医院胸外科2020年4月至2021年11月共57例接受RATS肺段切除术的患者临床资料,评估RATS肺段切除术的学习曲线,比较不同学习阶段的手术时间、切皮到机器人手术开始(docking)时间、术中出血量、术后并发症、术后住院时间、总花费。计数资料采用卡方检验或Fisher精确概率检验,计量资料采用t检验。结果:根据手术时间绘制回归曲线,分成学习阶段与熟练阶段两组,学习阶段19例,熟练阶段38例。学习阶段、熟练阶段两组在手术时间[(158.10±15.84)、(122.32±12.53)min,t=9.294,P<0.05]、术中出血量[(132.11±27.40)、(89.21±39.82)ml,t=4.214,P<0.05]、术后并发症[15.79%(3/19),2.63%(1/39),χ^(2)=3.480,Z=1.866,P<0.05]、术后住院时间[(6.92±1.99)、(4.53±1.50)d,t=5.084,P<0.05]、总费用[(82963.29±8735.70)、(76941.21±11120.52)元,t=2.061,P<0.05]进行比较,差异有统计学意义,而在docking时间[(25.89±4.71)、(24.24±5.00)min,t=1.202,P>0.05]则差异无统计学意义。结论:通过对达芬奇机器人肺段切除术学习曲线的精准分析,在19例即熟练阶段后能有更好的临床短期疗效,为患者节省费用,也能达到更好更精准的手术。Objective To summarize the early experience and evaluate the effectiveness of the robotic-assisted thoracoscopic surgery(RATS).Methods The clinical data of 57 patients receiving robotic assisted thoracoscopic anatomic segmentectomy from April 2020 to November 2021 in our department were reviewed.The operative time,docking time,blood loss,postoperative hospital stay,postoperative complications and cost were analyzed.The safety and feasibility were evaluated,and the learning curve was summed up.Count data were analyzed by using the chi-square test or Fisher exact test,and measurement data were analyzed by using the t test.Results The learning curve was drawn according to the operation time and patients were divided into two groups:learning stage and proficiency stage.Operative time[(158.10±15.84),(122.32±12.53)min,t=9.294,P<0.05],intraoperative blood loss[(132.11±27.40),(89.21±39.82)ml,t=4.214,P<0.05],postoperative complication rate[15.79%(3/19),2.63%(1/39),χ^(2)=3.480,Z=1.866,P<0.05],average hospital stay[(6.92±1.99),(4.53±1.50)d,t=5.084,P<0.05]and cost[(82963.29±8735.70),(76941.21±11120.52),t=2.061,P<0.05]between two groups were statistically significant.And the docking time[(25.89±4.71),(24.24±5.00)min,t=1.202,P>0.05]was not statistically significant.Conclusion Robotic-assisted anatomic segmentectomy surgery is safe and cost-effective in the early learning process,and the learning curve can be entered into the standard stage from the learning stage after initial 19 operations.

关 键 词：达芬奇机器人系统 解剖性肺段切除术 肺结节 学习曲线 

分 类 号：R655.3[医药卫生—外科学]