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中华胸部外科电子杂志 ›› 2026, Vol. 13 ›› Issue (02) : 102 -111. doi: 10.3877/cma.j.issn.2095-8773.2026.02.02

论著

单中心机器人辅助肺段切除术的安全性与可行性:一项回顾性分析
杨晓冬, 王子鸣, 赵德平, 朱余明()   
  1. 200433 上海,同济大学附属上海市肺科医院胸外科
  • 收稿日期:2026-01-21 修回日期:2026-03-05 接受日期:2026-05-25 出版日期:2026-05-28
  • 通信作者: 朱余明
  • 基金资助:
    国家自然科学基金(82203635); 上海市肺科医院新人培育人才计划(Fkxr2303)

A retrospective analysis of the safety and feasibility of robot assisted segmentectomy in a single center

Xiaodong Yang, Ziming Wang, Deping Zhao, Yuming Zhu()   

  1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
  • Received:2026-01-21 Revised:2026-03-05 Accepted:2026-05-25 Published:2026-05-28
  • Corresponding author: Yuming Zhu
  • About author:

    *Co-first authors.

引用本文:

杨晓冬, 王子鸣, 赵德平, 朱余明. 单中心机器人辅助肺段切除术的安全性与可行性:一项回顾性分析[J/OL]. 中华胸部外科电子杂志, 2026, 13(02): 102-111.

Xiaodong Yang, Ziming Wang, Deping Zhao, Yuming Zhu. A retrospective analysis of the safety and feasibility of robot assisted segmentectomy in a single center[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2026, 13(02): 102-111.

目的

回顾性分析单中心自达芬奇机器人手术系统投入使用后,开展机器人辅助肺段切除术的病例资料,总结其临床应用的安全性、可行性及围手术期结果,为该技术的推广与优化提供数据支持。

方法

纳入2020年10月至2023年12月期间于上海市肺科医院接受机器人辅助解剖性肺段切除术的472例患者。收集患者基线资料、手术细节、围手术期指标及并发症情况。主要观察终点为围手术期并发症,次要终点包括中转开胸率、手术时间、出血量、再入院率及死亡率。

结果

全组472例手术均顺利完成,无中转开胸或死亡病例。患者年龄(57.45±11.88)岁。手术量总体呈增长趋势。手术以双孔入路为主(72.0%),单孔比例逐步上升。手术时间为(100.19±41.93) min,并以此对学习曲线进行拟合。术中出血量<100 mL者占98.7%,仅1例(0.2%)需术中输血。术后住院时间为(3.29±1.54)天。总体并发症发生率较低,主要为持续性肺漏气者18例(3.8%)。术后30天再入院率为0.6%,90天内无死亡病例。单孔入路组手术时间、住院天数及术后早期引流量均显著优于多孔组。

结论

本研究初步证实,在经验丰富的中心,机器人辅助肺段切除术具有较高的安全性和可行性,围手术期并发症发生率低,短期结局良好。机器人手术是电视辅助胸腔镜肺段切除术的一种安全可行的替代选择,但其远期肿瘤学疗效仍需前瞻性研究进一步验证。

Objective

To retrospectively analyze the clinical data of patients undergoing robot-assisted segmentectomy since the implementation of the Da Vinci robotic surgical system at a single center, summarizing its safety, feasibility, and perioperative outcomes, thereby providing data support for the promotion and optimization of this technique.

Methods

A total of 472 patients who underwent robot-assisted anatomical segmentectomy in Shanghai Pulmonary Hospital between October 2020 and December 2023 were included. Baseline patient characteristics, surgical details, perioperative indicators, and complications were collected. The primary endpoint was perioperative complications. Secondary endpoints included conversion rate to thoracotomy, operative time, intraoperative blood loss, rates of 30-day readmission and 90-day mortality.

Results

All 472 procedures were completed successfully without conversion to thoracotomy or mortality. The mean patient age was (57.45±11.88) years. The overall surgical volume showed an increasing trend. The dual-port approach was predominant (72.0%), with a rising proportion of single-port surgeries. The mean operative time was (100.19±41.93) min. Fitting of the learning curve was performed based on operative time. Intraoperative blood loss was <100 mL in 98.7% of cases, with only one patient (0.2%) requiring intraoperative blood transfusion. The mean postoperative hospital stay was (3.29±1.54) days. The overall complication rate was low, mainly consisting of persistent air leak (18 patients, 3.8%). The 30-day readmission rate was 0.6%, with no deaths within 90 days. Single-port group had a significantly shorter operative time, hospital stay, and early drainage than the multi-port group.

Conclusions

This study preliminarily confirms that robot-assisted segmentectomy is safe and feasible in experienced centers, with a low perioperative complication rate and favorable short-term outcomes. Robotic surgery is a safe and viable alternative to video-assisted thoracoscopic segmentectomy, although its long-term oncological efficacy requires further validation by prospective studies..

表1 患者临床基线资料
表2 患者手术方式和术中情况
表3 不同手术阶段机器人肺段手术入路方式
图1 所有纳入病例中,胸外科医生A(A)和医生B(B)的机器人辅助肺段切除手术时间CUSUM图(按手术序号绘制)。CUSUM:累积和
表4 围手术期临床指标和术后并发症情况
表5 多孔和单孔RATS肺段切除手术术中情况、围手术期临床指标和术后并发症情况的比较
参数 多孔RATS(n=368) 单孔RATS(n=104) P
主病灶位置     0.560
右肺上叶 121(32.9) 39(37.5)  
右肺中叶 2(0.5) 2(1.9)  
右肺下叶 69(18.8) 16(15.4)  
左肺上叶 129(35.0) 35(33.7)  
左肺下叶 47(12.8) 12(11.5)  
广泛致密粘连     0.742
11(3.0) 2(1.9)  
357(97.0) 102(98.1)  
涉及肺亚段切除术     0.941
31(8.4) 9(8.7)  
337(91.6) 95(91.3)  
合并肺楔形切除术     0.575
54(14.7) 13(12.5)  
314(85.3) 91(87.5)  
手术时间(min) 105.00±42.50 83.14±35.01 <0.001
术中出血量(mL)     0.347
<100 362(98.4) 104(100.0)  
≥100 6(1.6) 0(0.0)  
术中输血     1.000
1(0.3) 0(0.0)  
367(99.7) 104(100.0)  
术后输血     1.000
3(0.8) 0(0.0)  
365(99.2) 104(100.0)  
术后住院时间(天) 3.39±1.62 2.92±1.16 0.019
引流量(mL)      
手术日术后 151.37±119.17 106.44±124.64 <0.001
术后第1天 157.51±129.02 115.71±91.69 0.003
术后第2天 118.33±94.38 88.50±65.82 0.048
术后第3天 114.01±108.92 91.03±87.72 0.338
术后并发症      
脑血管意外     1.000
2(0.5) 0  
366(99.5) 104(100.0)  
房颤等心律失常     0.048
0 2(1.9)  
368(100.0) 102(98.1)  
需要二次手术干预的血胸     1.000
9(2.4) 2(1.9)  
359(97.6) 102(98.1)  
肺栓塞     1.000
1(0.3) 0  
367(99.7) 104(100.0)  
支气管胸膜瘘     1.000
1(0.3) 0  
367(99.7) 104(100.0)  
乳糜胸     1.000
2(0.5) 0  
366(99.5) 104(100.0)  
呼吸衰竭     /
0 0  
368(100.0) 104(100.0)  
持续性肺漏气(>7天)     1.000
14(3.8) 4(3.8)  
354(96.2) 100(96.2)  
需要干预的气胸     1.000
1(0.3) 0  
367(99.7) 104(100.0)  
30天内再入院     1.000
3(0.8) 0  
365(99.2) 104(100.0)  
90天内死亡     /
0 0  
368(100.0) 104(100.0)  
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