摘要
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<100ml占95.8%,中转开胸4例(1.2%),围术期无输血病例,无术后30d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.MethodsRetrospective review was conducted on389consecutive patients who underwent robotic assisted lobectomy for clinical stageⅠtoⅢa of non small cell lung cancer at Shanghai lung Tumor Clinical Medical Center,Shanghai Chest Hospital between May2013and December2016.The maximum diameter of tumor on preoperative chest CT scan was(1.3±0.6)cm;153cases were in clinical stageⅠa,148inⅠb,32inⅠc,6inⅡb,30inⅢa;and the position of lesions for37cases was in left upper lobe,101in left lower lobe,105in right upper lobe,32in right middle lobe,114in right lower lobe;there were380cases of adenocarcinoma,and9cases of squamous carcinoma.Perioperative parameters and total hospital cost were analyzed.ResultsThe average operative time of all389RATS lobectomy was(91.5±30.8)min;95.8%of patients’estimated intraoperative blood loss were less than100ml;the conversion rate was1.2%(4cases);no patient received blood transfusion and no30day 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 for9.0%.The mean total hospital costs(self pay+insurance coverage)was(93809.23±13371.26)Yuan.ConclusionsDa Vinci surgical robotic system is safe and effective for the treatment of operable NSCLC,and it can overcome many disadvantages of traditional VATS.
作者
黄佳
李函玥
李重武
林皓
陆佩吉
李剑涛
罗清泉
HuangJia;Li Hanyue;Lichong wu;Lin Hao;Lu Peiji;LiJiantao;Luo Qingquan(Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, Shanghai Lung Tumor Clinical Medical Center, Shanghai200030, China)
出处
《中华胸部外科电子杂志》
2017年第4期199-203,共5页
CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition
关键词
非小细胞肺癌
达芬奇机器人手术系统
手术时间
住院费用
Non small cell lung cancer
Da Vinci surgical robotic system
Operative time
Hospital cost
