摘要
目的:评估机器人辅助亚肺叶联合切除手术的围术期安全性和短期疗效。方法:回顾性收集2015年1月~2020年8月在浙江大学医学院附属第一医院胸外科行亚肺叶联合切除手术的131例早中期非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者的临床资料,并根据手术方式分为机器人辅助胸腔镜手术(Robot-assisted thoracic surgery,RATS)组(20例)和电视胸腔镜辅助手术(Video-assisted thoracic surgery,VATS)组(111例)。根据基线资料对两组患者进行倾向性评分匹配,比较匹配后两组的围手术期结果。结果:倾向性评分匹配后最终纳入RATS组患者18例,VATS组患者56例。RATS组清扫了更多的N1淋巴结站数(P<0.05)和N1淋巴结个数(P<0.05),并且发现了更多的转移阳性的N_(2)淋巴结(P<0.05)。RATS组的术中出血量和胸腔引流管置放时间略少于VATS组,但差异无统计学意义(P>0.05)。RATS组的住院费用高于VATS组,但差异无统计学意义(P>0.05)。两组在淋巴结升期率、术后住院天数、术后第1d数字评分法疼痛(Numeric rating scales,NRS)评分、围术期并发症、术后辅助治疗方面无统计学差异。结论:机器人亚肺叶联合切除手术具有与胸腔镜手术相似的安全性和短期疗效,但RATS清扫淋巴结更彻底,且可减少术中出血和减少胸腔引流管置放时间。
Objective:To evaluate the perioperative safety and short-term outcomes of RATS in combined sublobectomy.Methods:A total of 131 patients with early to mid-stage NSCLC who underwent combined sublobectomy in department of thoracic surgery,the First Affiliated Hospital to Zhejiang University School of Medicine from January 2015 to August 2020 were selected and divided into Robot-assisted surgery(RATS)group(20 cases)and Video-assisted thoracoscopic surgery(VATS)group(111 cases)based on different surgical approaches.According to baseline data,propensity score matching(PSM)was performed on the two groups of patients and the perioperative results were compared after matching.Results:After PSM,18 patients in the RATS group and 56 patients in the VATS group were finally included.RATS group dissected more N1 lymph nodes(P<0.05)and stations(P<0.05),and defined more metastatic positive N_(2) lymph nodes(P<0.05).The intraoperative blood loss and time of thoracic drainage in the RATS group were slightly lower than those in the VATS group,but with no statistical significance(P>0.05).In addition,the hospitalization cost of the RATS group was higher than that of VATS group,but with no statistical significance(P>0.05).No statistical differences between the two groups on lymph node upstaging rate,postoperative hospital stay,NRS1(1st day after surgerg),perioperative complications,or postoperative adjuvant treatment were found.Conclusion:RATS in combined sublobectomy has similar safety and short-term efficacy to VATS,but it can do better in lymph node dissection and reducing intraoperative blood loss and catheter indwelling time.
作者
何天煜
王莺
刘佳聪
周春琳
庄润周
吕望
胡坚
HE Tianyu;WANG Ying;LIU Jiacong;ZHOU Chunlin;ZHUANG Runzhou;LV Wang;HU Jian(Department of Thoracic Surgery,the First Affiliated Hospital to Zhejiang University School of Medicine,Hangzhou 310003,China;Operating Room,the First Affiliated Hospital to Zhejiang University School of Medicine,Hangzhou 310003,China;College of Control Science and Engineering of Zhejiang University,Hangzhou 310027,China;Huzhou Research Institute of Zhejiang University,Huzhou 313000,China)
基金
国家重点研发计划(2017YFC0113500)
浙江省重大科技专项计划项目(2020C03058)
浙江省肺部肿瘤诊治技术研究中心(JBZX-202007)
浙江省医药卫生科技计划(2019KY069)。
作者简介
通讯作者:胡坚,Email:dr_hujian@zju.edu.cn。
