| 摘要: |
| ［摘要］ 目的 比较经剑突入路达芬奇机器人手术与电视胸腔镜手术（VATS）治疗前纵隔肿瘤疗效。方法 招募2020年1月至2023年1月广西壮族自治区人民医院收治的前纵隔肿瘤患者56例，根据手术方法不同分为机器人辅助胸腔镜手术（RATS）组（n=20例）和VATS组（n=36例），均经剑突入路。比较两组手术时间、术中出血量、48 h引流量、引流管留置时间、住院总费用，以及术后住院时间、视觉模拟量表（VAS）评分、并发症发生情况。结果 VATS组有1例患者因无名静脉紧密粘连于胸腺和1例患者因胸腺与心包胸膜、左上肺紧密粘连转开胸手术。RATS组无中转开胸手术或延长手术切口长度的患者。两组患者均手术成功。RATS组手术时间显著短于VATS组（P<0.05）。两组术中出血量、48 h引流量、引流管留置时间比较差异无统计学意义（P>0.05）。两组术后VAS评分均呈下降趋势。RATS组术后第1天、第2天、第3天的VAS评分均低于VATS组，差异有统计学意义（P<0.05）。两组并发症发生率比较差异无统计学意义（5.88% vs 0.00%；P=0.525）。RATS组住院费用高于VATS组，差异有统计学意义（P<0.05）。两组术后住院时间比较差异无统计学意义（P>0.05）。结论 RATS是治疗前纵隔病变安全可行的方法，相较于VATS，RATS对减少患者术后疼痛有积极意义，利于患者快速康复。 |
| 关键词: 机器人辅助胸腔镜手术 电视胸腔镜手术 剑突入路 前纵隔肿瘤 |
| DOI：10.3969/j.issn.1674-3806.2024.04.17 |
| 分类号:R 605 |
| 基金项目:南宁市青秀区科技计划项目（编号：2020029） |
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| Comparison of therapeutic effects between Da Vinci robot surgery by subxiphoid approach and video-assisted thoracoscopic surgery by subxiphoid approach for anterior mediastinal tumors |
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SUN Zhendong1, ZHOU Yifan2, XU Ruihong2, SHEN Bin2, LUO Jinlong2, LI Xiangwei2, LIU Songtao2, SUN Siyuan1
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1.Youjiang Medical University for Nationalities, Baise 533000, China; 2.Department of Cardiothoracic Vascular Surgery, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To compare the therapeutic effects between Da Vinci robot surgery by subxiphoid approach and video-assisted thoracoscopic surgery(VATS) by subxiphoid approach for anterior mediastinal tumors. Methods A total of 56 patients with anterior mediastinal tumors who were admitted to the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2020 to January 2023 were recruited and divided into robot-assisted thoracoscopic surgery(RATS) group(n=20) and VATS group(n=36) according to different surgical methods. All the patients were operated using subxiphoid approach. The operation time, intraoperative blood loss, 48-hour drainage volume, catheter retention time, total hospitalization cost, postoperative hospital stay, Visual Analogue Scale(VAS) score and complications were compared between the two groups. Results In the VATS group, 1 patient underwent a conversion to thoracotomy due to the close adhesion of the innominate vein to the thymus, and 1 patient underwent a conversion to thoracotomy due to the close adhesion of the thymus to the pericardium pleura and the left upper lung. In the RATS group, no patients underwent a conversion to thoracotomy or extended incision length. The operations were successful in the patients in both groups. The operation time of the RATS group was significantly shorter than that of the VATS group(P<0.05), but there were no significant differences in the intraoperative blood loss, 48-hour drainage volume and catheter retention time between the two groups(P>0.05). The postoperative VAS scores in both groups showed a downward trend. The VAS scores of the RATS group on day 1, day 2 and day 3 after surgery were lower than those of the VATS group, and the differences were statistically significant(P<0.05). There was no significant difference in the incidence of complications between the two groups(5.88% vs 0.00%; P=0.525). The hospitalization cost of the RATS group was higher than that of the VATS group, and the difference was statistically significant(P<0.05). There was no significant difference in postoperative hospital stay between the two groups(P>0.05). Conclusion RATS is a safe and feasible method for the treatment of anterior mediastinal lesions. Compared with VATS, RATS has positive significance in reducing the patients′ postoperative pain and is conducive to their rapid recovery. |
| Key words: Robot-assisted thoracoscopic surgery(RATS) Video-assisted thoracoscopic surgery(VATS) Subxiphoid approach Anterior mediastinal tumor |
