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目的总结应用达芬奇机器人手术系统行纵隔支气管源性囊肿切除手术的经验。方法回顾性分析我科2009年7月~2013年9月25例手术治疗并经术后病理证实为支气管源性囊肿的临床资料,其中应用电视胸腔镜手术切除9例(2011年3月前),应用达芬奇机器人手术系统切除16例(2011年3月后),对手术时间、术中出血量、术后拔管时间、术后住院时间等进行比较。结果胸腔镜组1例术中见囊肿与右主支气管形成瘘口,行瘘口修补,术后发生脓胸,再次行脓胸清除术后恢复良好;机器人组1例术中见囊肿与食管关系密切,在胃镜辅助下行囊肿大部切除。其余病例均顺利完成手术。2组手术时间差异无显著性[机器人组(84.1±37.6)min,胸腔镜组(128.8±73.4)min,t=-2.031,P=0.054],术中出血量、术后引流时间、术后住院时间机器人组均小于胸腔镜组[出血量:中位数5 ml(0~50 ml)vs.20 ml(0~600 ml),Z=-2.169,P=0.030;术后引流时间:2 d(1~8 d)vs.5 d(1~12 d),Z=-2.285,P=0.022);术后住院时间:(5.8±2.4)d vs.(11.0±6.3)d,t=-3.003,P=0.006]。术后随访机器人组1~20个月[(12.1±6.8)月],胸腔镜组24~51个月[(36.1±9.5)月],均恢复良好,无复发。结论与胸腔镜手术相比,应用达芬奇机器人手术系统治疗纵隔支气管源性囊肿,具有安全、术中出血量少、术后引流时间和住院时间短等优势。
Objective To summarize the experience of resection of mediastinal bronchogenic cysts using the Da Vinci robotic surgery system. Methods The clinical data of 25 patients with surgically treated bronchogenic cysts from July 2009 to September 2013 were retrospectively analyzed. Among them, 9 cases were treated by video-assisted thoracoscopic surgery (before March 2011) Sixteen cases were removed by Da Vinci robotic surgery system (after March 2011). The operation time, intraoperative blood loss, postoperative extubation time and postoperative hospital stay were compared. Results One case of thoracoscopic group was found cyst and right main bronchial fistula, fistula repair, postoperative empyema, empyema clear again postoperative recovery was good; robotic group, 1 case, see the cyst and esophageal surgery Close, assisted in the descending endoscopy gastrostomy. The remaining cases were successfully completed surgery. There was no significant difference in operative time between the two groups (84.1 ± 37.6 min in robot group, 128.8 ± 73.4 min in thoracoscopic group, t = -2.031, P = 0.054), intraoperative blood loss, postoperative drainage time, The number of hospital stay was lower in the robotic group than in the thoracoscopic group [bleeding volume: median 5 ml (0-50 ml) vs. 20 ml (0-600 ml), Z = -2.169, P = 0.030; postoperative drainage time: 2 (5.8 ± 2.4) days vs. (11.0 ± 6.3) days, d = (1- 8 d) vs.5 d (1-12 d), Z = -2.285, P = 0.022) -3.003, P = 0.006]. The patients in the robot group were followed up for 1 to 20 months [(12.1 ± 6.8) months) and those in the thoracoscopic group (24 to 51 months [(36.1 ± 9.5) months) recovered well without recurrence. Conclusion Compared with thoracoscopic surgery, the application of Da Vinci robotic surgery system for the treatment of mediastinal bronchogenic cysts has the advantages of safety, less blood loss, shorter postoperative drainage time and shorter hospital stay.