机器人辅助经前侧通用入路全胸膜腔闭锁下右肺上叶后段切除术一例报道(附手术视频)  

Robot-assisted posterior segmentectomy of the right upper lobe under total pleural cavity atresia through the anterior universal approach:a case report(with surgical video)

作　　者：陶绍霖 张祖旺 齐东东 康珀铭 谭群友 TAO Shaolin;ZHANG Zuwang;QI Dongdong;KANG Poming;TAN Qunyou(Department of Thoracic Surgery,University-Town Hospital of Chongqing Medical University,Chongqing 401331,China)

机构地区：[1]重庆医科大学附属大学城医院胸外科,重庆401331

出　　处：《机器人外科学杂志(中英文)》2025年第4期542-546,共5页Chinese Journal of Robotic Surgery

基　　金：重庆市科卫联合医学科研项目面上项目(2025MSXM142)。

摘　　要：目的:探讨经前侧入路机器人辅助胸腔镜手术(RATS)在处理复杂胸膜腔闭锁情况下的临床应用及技术优势,报道一例右肺上叶后段(S2)切除病例。方法:患者因右肺上叶后段早期肺癌合并全胸膜腔闭锁,于2024年8月22日使用机器人辅助经前侧入路行外科手术治疗。术前采用三维软件规划手术方案,术中采用本团队独创的经前侧肺切除通用入路,即“4-6-8”三孔位设计方法,在手术机器人辅助下完成胸膜粘连松解、右肺上叶后段切除术。在完成肿瘤根治基础上最大限度保留健康肺组织、减少创伤。结果:手术顺利完成,手术时长235 min,其中Docking时间20 min,手术机器人腔内操作时间190 min(全胸膜粘连松解时间110 min);出血量约120 mL,术后轻度漏气,持续引流10 d后恢复,无其他并发症发生;术后病理提示微小浸润性腺癌;患者顺利出院。结论:RATS在复杂胸膜粘连情况下能够显著提升手术精确度,拓宽手术适应证,同时经前侧三孔设计方法优化了手术入路和操作空间,为高难度胸外科手术提供了重要技术支持。Objective:To explore the clinical utility and technical advantages of robot-assisted thoracoscopic surgery(RATS)via an anterior approach for complex pleural adhesions,with a case presentation of right upper lobe posterior segment(S2)resection.Methods:A patient with early-stage lung cancer in the S2 segment and diffuse pleural adhesions underwent RATS via anterior approach on August 22,2024.Preoperative 3D surgical planning was performed.Intraoperatively,the team’s proprietary“4-6-8”three-port universal anterior approach was adopted to complete adhesiolysis and S2 segmentectomy under robotic assistance,maximizing parenchymal preservation and minimizing trauma while ensuring oncological radicality.Results:The procedure was successful,the surgery lasted 235 min;including a docking time of 20 min and a console time of 190 min(110 min for adhesiolysis).Intraoperative blood loss was 120 mL.Postoperative air leak persisted for 10 days without other complications.Pathology confirmed minimally invasive adenocarcinoma.The patient recovered uneventfully.Conclusion:RATS significantly enhances precision and expands indications for complex pleural adhesions.The anterior 3-port approach optimizes surgical access and operative space,providing critical technical support for challenging thoracic procedures.

关 键 词：机器人辅助胸腔镜手术 肺段切除术 胸膜腔闭锁 肺腺癌 

分 类 号：R655.3[医药卫生—外科学] R734.2[医药卫生—临床医学]