切换至 "中华医学电子期刊资源库"

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/OL]. 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/OL]. 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.

1
Thomas P, Doddoli C, Yena S, et al. VATS is an adequate oncological operation for stage Ⅰ non-small cell lung cancer[J]. Eur J Cardiothorac Surg, 2002,21(6):1094-1099.
2
Roviaro GC, Varoli F, Vergani C,et al. State of the art in thoracospic surgery: a personal experience of 2000 videothoracoscopic procedures and an overview of the literature[J]. Surg Endosc, 2002,16(6):881-892.
3
Nagahiro I, Andou A, Aoe M, et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure[J].Ann Thorac Surg, 2001,72(2):362-365.
4
Forster R, Storck M, Schafer JR, et al.Thoracoscopy versus thoracotomy: a prospective comparison of trauma and quality of life[J]. Langenbecks Arch Surg 2002,387(1):32-36.
5
Nifong LW, Chu VF, Bailey BM, et al. Robotic mitral valve repair: experience with the da Vinci system[J]. Ann Thorac Surg, 2003,75(2):438-442.
6
Tewari A, Peabody J, Sarle R, et al. Technique of da Vinci robot-assisted anatomic radical prostatectomy[J]. Urology, 2002,60(4):569-572.
7
Melfi FM, Mussi A. Robotically assisted lobectomy: learning curve and complications[J]. Thorac Surg Clin, 2008,18(3):289-295.
8
Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery:personal experience in a large community hospital[J]. Arch Surg, 2003,138(7):777-784.
9
Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results[J]. J Thorac Cardiovasc Surg,2006, 131(1):54-59.
10
Gharagozloo F, Margolis M, Tempesta B, et al. Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases[J]. Ann Thorac Surg 2009; 88(2):380-384.
11
刘伦旭,车国卫,蒲强,等. 单项式全胸腔镜肺叶切除[J]. 中华胸心血管外科杂志,2008, 24(3):156-158
12
Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer[J]. J Thorac Cardiovasc Surg, 2010,140(1):19-25.
13
Augustin F, Bodner J, Wykypiel H, et al. Initial experience with robotic lung lobectomy: report of two different approaches[J]. Surg Endosc, 2011, 25(1):108-113.
14
Bodner J, Wykypiel H, Wetscher G, et al. First experiences with the da Vinci operating robot in thoracic surgery[J]. Eur J Cardiothorac Surg, 2004, 25(5):844-851.
15
Zhao X, Qian L, Lin H, et al. Robot-assisted lobectomy for nonsmall cell lung cancer in China: initial experience and techniques[J]. J Thorac Dis, 2010, 2(1):26-28.
16
Anderson CA, Hellan M, Falebella A, et al. Robotic-assisted lung resection for malignant disease[J]. Innovations (Phila), 2007, 2(5):254-258.
17
Giulianotti PC, Buchs NC, Caravaglios G, et al. Robot-assisted lung resection: outcomes and technical details[J]. Interact Cardiovasc Thorac Surg, 2010, 11(4):388-392.
18
Whitson BA, D’Cunha J, Andre RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity[J].Ann Thorac Surg, 2008, 86(6):1735-1744.
19
Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms[J]. J Thorac Cardiovasc Surg,2011, 142(4):740-746.
20
Chang L, Satava RM, Pellegrini CA, et al. Robotic surgery:identifing the learning curve through objective mearsurement of skill[J].Surg Endosc,2003,17(11):1744-1748.
21
Hernandez J,Bann S,Munz K,et al.Qualitative and quantitative analysis of the learning curve of a simulated task on the da Vinci system[J].Surg Endosc, 2004,18(3):372-378.
22
Jane HJ,Lee HS,Park SY,et al.Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer: a single-institution case series matching study[J]. Innovations(Phila),2011,6(5):305-310.
23
Park BJ,Flores RM.Cost comparison of robotic,vats and thoracotomy approaches to pulmonary lobectomy[J]. Thorac Surg Clin, 2008,18(3):297-300.
[1] 张礼江, 沈玲佳, 施我大. 倾向性评分匹配分析奥希替尼对晚期NSCLC 预后的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 820-822.
[2] 杨慧, 郭丽娟, 冯晓丹, 李静, 黄成谋, 蔡兴锐, 覃英娇, 王远礼. 非小细胞肺癌铂类药物耐药mi RNA表达特征及预测分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 719-724.
[3] 赖淼, 景鑫, 李桂珍, 李怡. 非小细胞肺癌EGFR 突变亚型的临床病理和预后意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 731-737.
[4] 梁丽斯, 李洁, 贺帅, 来艳君, 刘铭, 张琳. MMP-9、MMP-2 及TLR4、HE4对非小细胞肺癌早期诊断意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 756-761.
[5] 赵蒙蒙, 黄洁, 余荣环, 王葆青. 过表达小GTP酶Rab32抑制非小细胞肺癌细胞侵袭性生长[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 512-518.
[6] 张桂萍, 丘勇林, 湛绮婷, 孙乐栋. 晚期非小细胞肺癌血清Ape1/Ref-1对放射性肺损伤发生的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 519-523.
[7] 韩晓宇, 李柯育, 赵志菲, 高建平. SNHG17过表达对非小细胞肺癌切除术预后的意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 543-547.
[8] 刘松, 张进召, 贾艳云. 帕博利珠单抗治疗晚期非小细胞肺癌反应降低与抗生素预处理的关系[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 553-557.
[9] 李多, 郝昭昭, 陈延伟, 南岩东. 血清PTX3表达与非小细胞肺癌骨转移的相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 558-562.
[10] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
[11] 崔伟, 邓屹, 叶苏意, 李静, 陈晓明, 张靖, 许荣德. 载药微球支气管动脉化疗栓塞术治疗罕见非小细胞肺癌的临床疗效和安全性分析[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 303-310.
[12] 崔伟, 叶苏意, 邓屹, 陈晓明, 张靖, 李静, 许荣德. 载药微球支气管动脉化疗栓塞术治疗难治性非小细胞肺癌的临床疗效及安全性[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 311-316.
[13] 崔伟, 李静, 陈晓明, 张靖, 邓屹, 许荣德. 载药微球支气管动脉化疗栓塞术治疗非小细胞肺癌的研究进展[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 289-295.
[14] 蔡剑桥, 蒋雷. 单孔胸腔镜与开胸双袖式肺叶切除治疗非小细胞肺癌对比[J/OL]. 中华胸部外科电子杂志, 2024, 11(04): 225-230.
[15] 张迅夫, 马金山, 蒋云龙, 加纳提·托勒恒, 侯昌剑, 萨伍提·斯拉吉丁. GATA3在非小细胞肺癌组织中的表达及临床病理意义[J/OL]. 中华胸部外科电子杂志, 2024, 11(03): 175-179.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?