da Vinci机器人辅助胸腔镜下切除儿童后纵隔肿瘤的初步经验:与传统胸腔镜手术的比较研究  

Preliminary Experience in da Vinci Robot-assisted Thoracoscopic Resection of Posterior Mediastinal Masses in Children:A Comparative Study with Conventional Thoracoscopic Surgery

作　　者：甘恩 王晨[1] 刘源 普佳睿 李帅[1] 汤绍涛[1] 李时望[1] Gan En;Wang Chen;Liu Yuan(Department of Pediatric Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科,武汉430022

出　　处：《华中科技大学学报(医学版)》2025年第1期101-105,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81372401)。

摘　　要：目的 探讨da Vinci机器人辅助胸腔镜下切除儿童后纵隔肿瘤与传统胸腔镜手术比较的优缺点。方法 收集2018年1月至2021年10月在华中科技大学同济医学院附属协和医院住院并接受后纵隔肿瘤切除手术患儿79例,达芬奇机器人辅助下胸腔镜手术47例(A组),传统胸腔镜手术32例(B组)。比较分析两组患儿年龄、性别、体重、肿瘤类型、肿瘤大小、手术时间、术中及术后并发症等情况。结果 患儿男44例,女35例,平均年龄4.5岁[(4.7±2.4)岁vs.(4.4±1.8)岁,P=0.19],平均体重21.7 kg[(23.6±7.5)kg vs.(20.9±6.1)kg,P=0.10],肿瘤大小[(5.2±3.1)cm vs.(4.5±2.3)cm,P=0.07]。所有手术均安全完成,无手术死亡病例。病理结果显示神经节细胞肿瘤25例,节细胞神经母细胞瘤19例,神经母细胞瘤16例,淋巴管瘤10例,前肠囊肿8例,脂肪母细胞瘤1例。1例患儿因术中出血而中转开胸。平均麻醉时间为(127±25)min vs.(124±30)min(P=0.42),手术操作时间(84±17)min vs.(102±27)min(P=0.02),术中估计出血量为(14.6±4.4)mL vs.(15.4±5.3)(P=0.38),胸腔引流时间(3.7±2.5)d vs.(4.1±3.0)d (P=0.09),平均住院天数为(7.2±1.9)d vs.(7.4±2.3)d (P=0.40)。术后并发症A组乳糜胸1例,气胸3例,霍纳综合征1例;B组血胸1例,气胸4例,霍纳综合征1例。节细胞神经母细胞瘤及神经母细胞瘤予以术后化疗。术后随访2~5年,患儿均恢复良好,无复发病例。结论 da Vinci手术机器人与传统胸腔镜手术在儿童纵隔肿瘤手术中均安全可行。达芬奇手术机器人手术系统优化的器械使其在体积大的肿瘤或解剖结构复杂的肿瘤中更具优势。Objective To explore the advantages and disadvantages of da Vinci robotic-assisted thoracoscopic resection of pediatric posterior mediastinal tumors compared to traditional thoracoscopic surgery.Methods A total of 79 pediatric patients who underwent posterior mediastinal tumor resection at Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,between January 2018 and October 2021 were included.Among them,47 patients underwent da Vinci robotic-assisted thoracoscopic surgery(Group A),and 32 patients underwent traditional thoracoscopic surgery(Group B).The patients' age,gender,weight,tumor type,size,surgical time,intraoperative and postoperative complications,and other factors were compared and analyzed.Results There were 44 male and 35 female patients,with an average age of 4.5 years[(4.7 ± 2.4)vs.(4.4 ± 1.8),P=0.19]and an average weight of 21.7 kg[(23.6 ± 7.5)vs.(20.9 ± 6.1),P=0.10].Tumor sizes were(5.2 ± 3.1)cm vs.(4.5 ± 2.3)cm(P=0.07).All surgeries were completed safely with no intraoperative deaths.Pathological results showed 25 cases of ganglioneuroma,19 cases of ganglioneuroblastoma,16 cases of neuroblastoma,10 cases of lymphangioma,8 cases of foregut cyst,and 1 case of lipoblastoma.One patient required conversion to thoracotomy due to intraoperative bleeding.The average anesthesia time[(127 ± 25)vs.(124 ± 30)min,P=0.42]and the operative time[(84 ± 17)vs.(102 ± 27)min,P=0.02)]were significantly different.Estimated intraoperative blood loss[(14.6 ± 4.4)vs.(15.4 ± 5.3)mL,P=0.38]and the chest drainage time[(3.7 ± 2.5)vs.(4.1 ± 3.0)days,P=0.09]varied between groups.The average lengths of hospital stay were different[(7.2 ± 1.9)vs.(7.4 ± 2.3)days,P=0.40].Postoperative complications included 1 case of chylothorax,3 cases of pneumothorax,and 1 case of Horner's syndrome in Group A.There were 1 case of hemothorax,4 cases of pneumothorax,and 1 case of Horner's syndrome in Group B.Patients with ganglioneuroblastoma and neuroblastoma received postoperative chemotherapy.Follow

关 键 词：da Vinci机器人 胸腔镜 纵隔肿瘤 儿童 微创手术 

分 类 号：R655.5[医药卫生—外科学]