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中华胸部外科电子杂志 ›› 2017, Vol. 04 ›› Issue (04) : 199 -203. doi: 10.3877/cma.j.issn.2095-8773.2017.04.01

所属专题: 机器人专题 机器人手术 文献

论著

连续389例达芬奇机器人辅助胸腔镜肺叶切除术治疗非小细胞肺癌经验总结
黄佳1, 李函玥1, 李重武1, 林皓1, 陆佩吉1, 李剑涛1, 罗清泉1,()   
  1. 1. 200030 上海交通大学附属胸科医院胸外科,上海市肺部肿瘤临床医学中心
  • 收稿日期:2017-09-08 出版日期:2017-11-28
  • 通信作者: 罗清泉

The experience of 389 cases of robotic assisted lobectomy for the treatment of non-small cell lung cancer

Jia Huang1, Hanyue Li1, chong wu Li1, Hao Lin1, Peiji Lu1, Jiantao Li1, Qingquan Luo1,()   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
  • Received:2017-09-08 Published:2017-11-28
  • Corresponding author: Qingquan Luo
  • About author:
    Corresponding author: Luo Qingquan, Email:
引用本文:

黄佳, 李函玥, 李重武, 林皓, 陆佩吉, 李剑涛, 罗清泉. 连续389例达芬奇机器人辅助胸腔镜肺叶切除术治疗非小细胞肺癌经验总结[J]. 中华胸部外科电子杂志, 2017, 04(04): 199-203.

Jia Huang, Hanyue Li, chong wu Li, Hao Lin, Peiji Lu, Jiantao Li, Qingquan Luo. The experience of 389 cases of robotic assisted lobectomy for the treatment of non-small cell lung cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2017, 04(04): 199-203.

目的

分析非小细胞肺癌(NSCLC)患者在行达芬奇机器人辅助下胸腔镜(RATS)肺叶切除术后的围术期指标,并总结手术经验。

方法

回顾性分析上海市胸科医院肺部肿瘤中心2013年5月—2016年12月连续389例行RATS肺叶切除术的Ⅰ~Ⅲa期NSCLC患者的临床资料。术前胸部CT扫描测量肿瘤直径(1.3±0.6)cm;临床病理分期:Ⅰa期153例,Ⅰb期148例,Ⅰc期32例,Ⅱb期26例,Ⅲa期30例;病灶位置:左肺上叶37例,左肺下叶101例;右肺上叶105例,右肺中叶32例,右肺下叶114例;腺癌380例,鳞癌9例。对围术期各项观察指标及住院总费用进行统计分析。

结果

389例行RATS肺叶切除术的患者平均手术时间(91.5±30.8)min,术中估计出血量<100 ml占95.8%,中转开胸4例(1.2%),围术期无输血病例,无术后30 d内死亡病例。患者均行系统性淋巴结清扫,平均每例取淋巴结(5.7±1.5)组和(9.8±3.4)枚。术后第1天平均引流量(231.4±141.9)ml;术后留置胸管时间(4.0±1.5)d,无带管出院患者;术后平均住院时间(5.0±1.5)d,术后漏气(9.0%)为并发症的主要原因。患者平均住院总费用(自费部分+医保覆盖部分)(93 809.23元±13371.26)元。

结论

达芬奇机器人外科手术系统用于治疗可切除NSCLC患者安全、有效,可很好地弥补传统胸腔镜手术的不足。

Objective

To analyze the perioperative parameters of non-small cell lung cancer patients who underwent robotic assisted lobectomy and summarize the surgical experience.

Methods

Retrospective review was conducted on 389 consecutive patients who underwent robotic-assisted lobectomy for clinical stage Ⅰ to Ⅲa of non-small cell lung cancer at Shanghai lung Tumor Clinical Medical Center, Shanghai Chest Hospital between May 2013 and December 2016. The maximum diameter of tumor on preoperative chest CT scan was(1.3±0.6)cm; 153 cases were in clinical stage Ⅰa, 148 in Ⅰb, 32 in Ⅰc, 6 in Ⅱb, 30 in Ⅲa; and the position of lesions for 37 cases was in left upper lobe, 101 in left lower lobe, 105 in right upper lobe, 32 in right middle lobe, 114 in right lower lobe; there were 380 cases of adenocarcinoma , and 9 cases of squamous carcinoma. Perioperative parameters and total hospital cost were analyzed.

Results

The average operative time of all 389 RATS lobectomy was(91.5±30.8)min; 95.8 % of patients’ estimated intraoperative blood loss were less than 100 ml; the conversion rate was 1.2% (4 cases); no patient received blood transfusion and no 30-day postoperative mortality occurred. All patients underwent systematic lymphadenectomy, and the average station and number of lymph nodes dissected were(5.7±1.5)and (9.8±3.4)respectively. The mean volume of chest tube drainage on the first postoperative day was(231.4±141.9)ml; the drainage period was (4.0±1.5)d and no patient was discharged with chest tube; the average postoperative hospital stay was(5.0±1.5)d; postoperative air leak was the primary complication, accounting for 9.0%. The mean total hospital costs (self pay + insurance coverage) was(93 809.23±13 371.26)Yuan.

Conclusions

Da Vinci surgical robotic system is safe and effective for the treatment of operable NSCLC, and it can overcome many disadvantages of traditional VATS.

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