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ENGLISH ABSTRACT
ⅠA期非小细胞肺癌行达芬奇机器人和电视胸腔镜肺段切除术近期疗效对比分析
柴新春
许世广
刘博
刘大治
李博
徐惟
王希龙
丁仁泉
刘德宇
王述民
作者及单位信息
·
DOI： 10.3760/cma.j.cn112434-20200926-00440
A comparative analysis of the short-term efficacy of lung segmentectomy by Da Vinci robot and video-assisted thoracoscopy for stage ⅠA non-small cell lung cancer
Chai Xinchun
Xu Shiguang
Liu Bo
Liu Dazhi
Li Bo
Xu Wei
Wang Xilong
Ding Renquan
Liu Deyu
Wang Shumin
Authors Info & Affiliations
Chai Xinchun
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Xu Shiguang
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Liu Bo
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Liu Dazhi
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Li Bo
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Xu Wei
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Wang Xilong
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Ding Renquan
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Liu Deyu
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
Wang Shumin
Department of Thoracic Surgery, General Hospital of Northern Theater Command, Graduate Training Base of General Hospital of Northern Theater Command, Shenyang 110016, China
·
DOI： 10.3760/cma.j.cn112434-20200926-00440
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摘要

目的对比ⅠA期非小细胞肺癌行两种手术方式肺段切除的近期疗效。

方法回顾性分析2016年7月至2020年7月北部战区总医院胸外科收治的临床诊断为ⅠA期非小细胞肺癌并行肺段切除术的患者101例，其中行达芬奇机器人肺段切除术50例(RATS组)，同期行电视胸腔镜肺段切除术51例(VATS组)，通过收集患者临床资料，对比分析两种手术方式手术时间、术中出血量、淋巴结清扫站数、淋巴结清扫数目、术后1天胸腔引流量、术后3天胸腔总引流量、术后胸腔引流管带管时间、术后住院天数以及术后并发症发生率等。

结果全组患者均顺利完成肺段切除术，无中转开胸及围术期死亡病例。术中出血量[(34.40±12.96)ml对(85.10±26.41)ml， P＝0.000 ]、淋巴结清扫站数[(4.72±1.20)站对(3.60±1.40)站， P＝0.000]及淋巴结清扫数目[(15.14±5.91)枚对(10.76±5.26)枚， P＝0.000]，RATS组均优于VATS组，差异具有统计学意义( P<0.05)；两组手术时间[(153.90±21.88)min对(155.39±25.04)min， P＝0.751]、术后1天胸腔引流量[(217.80±76.94)ml对(210.98±86.98)ml， P＝0.678]、术后3天胸腔总引流量[(612.60±169.93)ml对(595.10±203.90)ml， P＝0.641]、术后胸腔引流管带管时间[(5.36±2.33)天对(5.18±2.54)天， P＝0.706]、术后住院天数[(7.50±2.35)天对(7.47±2.93)天， P＝0.956]及术后并发症发生率差异无统计学意义( P>0.05)。

结论对于ⅠA期非小细胞肺癌，达芬奇机器人肺段切除术是一种安全、有效的手术方式，较电视胸腔镜肺段切除术中出血更少，淋巴结清扫站数及数目更多。

达芬奇机器人手术;电视辅助胸腔镜手术;肺段切除术;ⅠA期非小细胞肺癌
ABSTRACT

ObjectiveTo compare the short-term outcomes of segmentectomy for stage ⅠA non-small cell lung cancer by two surgical methods.

MethodsA retrospective analysis was performed on 101 patients with stage ⅠA non-small cell lung cancer and undergoing segmentectomy admitted to the Department of Thoracic Surgery of The General Hospital of the Northern Theater Command from July 2016 to July 2020, including 50 patients who underwent Da Vinci robotic segmentectomy and 51 patients who underwent video-assisted thoracoscopic segmentectomy during the same period. By collecting the clinical data of the patients, the operation time, intraoperative blood loss, lymph node dissection stations, lymph node dissection number, drainage volume on the first day after the operation, total drainage volume on the third day after the operation, postoperative chest catheter insertion time, postoperative hospitalization days, and postoperative complication rate were compared and analyzed.

ResultsPatients in both groups successfully completed pulmonary segmental resection, and there were no cases of conversion to thoracotomy and perioperative death.Compared and analyzed the postoperative clinical results of the two groups, the intraoperative blood loss [(34.40±12.96) ml vs.(85.10±26.41)ml, P=0.000], the number of lymph node dissection stations(4.72±1.20 vs. 3.60±1.40, P=0.000) and the number of lymph node dissection(15.14±5.91 vs. 10.76±5.26, P=0.000) showed statistically significant differences, and RATS group was superior to VATS group.There were no statistically significant differences in operation time[(153.90±21.88) min vs.(155.39±25.04) min, P=0.751], drainage volume on the first day after surgery[(217.80±76.94) ml vs.(210.98±86.98) ml, P=0.678], total drainage volume three days after surgery[(612.60±169.93) ml vs.(595.10±203.90) ml, P=0.641], duration of chest drainage tube after operation[(5.36±2.33) days vs.(5.18±2.54) days, P=0.706], postoperative hospitalization days[(7.50±2.35) days vs.(7.47±2.93) days, P=0.956]and postoperative complication incidence.

ConclusionDa Vinci robot segmentectomy is a safe and effective surgical method, with less bleeding and more lymph node dissection stations and number than video-assisted thoracoscopic segmentectomy for stage ⅠA non-small cell lung cancer.

Da Vinci robot surgery;Video-assisted thoracic surgery;Lung segmentectomy;Stage ⅠA non-small cell lung cancer
Wang Shumin Email: mocdef.3ab61ognoc3002namerus
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引用本文

柴新春,许世广,刘博,等. ⅠA期非小细胞肺癌行达芬奇机器人和电视胸腔镜肺段切除术近期疗效对比分析[J]. 中华胸心血管外科杂志,2021,37(11)：644-648.

DOI:10.3760/cma.j.cn112434-20200926-00440

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肺癌目前仍然是我国发病率和病死率最高的恶性肿瘤 [ 1 ]，随着居民医疗保健意识的提高以及低剂量螺旋计算机断层扫描(low-dose computed tomography LDCT)的不断普及，早期肺癌的检出率大幅增加 [ 2 , 3 , 4 ]。肺癌各种类型中，非小细胞肺癌约占80%以上，治疗上传统肺癌手术的金标准是肺叶切除加纵隔淋巴结清扫术 [ 5 ]，但近年来研究显示对于ⅠA期非小细胞肺癌实施肺段切除可以取得和肺叶切除相当的疗效，同时可以保留更多健康的肺组织，增加术后肺功能以提高生活质量 [ 6 , 7 , 8 ]。临床上电视胸腔镜肺段切除术开展得较为广泛，而达芬奇机器人手术作为外科手术领域最先进的技术，因其微创、精细、灵活及智能化已经广泛应用于胸外科肺部疾病、纵隔肿瘤及食管疾病的外科手术治疗中，取得了和电视胸腔镜手术相当的手术效果 [ 9 , 10 , 11 ]。目前临床上对于肿瘤直径≤2 cm的ⅠA期非小细胞肺癌，行达芬奇机器人和电视胸腔镜肺段切除术的手术效果对比研究较少，本研究的目的是提供完整的临床数据，评价两种手术方式的疗效。
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