达芬奇机器人与胸腔镜肺段切除术治疗早期非小细胞肺癌的有效性对比

目的:对比研究达芬奇机器人与胸腔镜下肺段切除术患者的围手术期数据,评价机器人肺段切除术的临床价值.方法:回顾性分析2018年12月～2020年2月在郑州大学第一附属医院胸外科行机器人肺段切除术68例患者(机器人组)和胸腔镜下肺段切除术49例患者(胸腔镜组)的临床资料.比较两组患者肺段切除类型、术后疼痛评分、住院费用、手术时间、术中失血量、清扫淋巴结组数及个数、术后住院时间、胸腔引流管留置时间、引流总量以及术后并发症发生情况,从而明确两种手术方式的有效性差异.结果:机器人组比胸腔镜组术后疼痛评分更低(1.94±0.64)分Vs(2.29±0.65)分,P<0.05];N1淋巴结清扫的组数1(1～2)组Vs 2(1～3)组,P=0.002]和数量2(1～3)枚Vs 3(1～4)枚,P=0.014]有差异,机器人组优于胸腔镜组;住院费用为80815.00(47914.79～113023.66)元和98213.41(65302.90～155561.88)元,机器人组高于胸腔镜组(P<0.05).结论:机器人和胸腔镜肺段切除术对非小细胞肺癌的早期治疗是安全可行的,而机器人肺段切除术可能有更好的N1淋巴结清扫效果.

A comparative study on effectiveness of Da Vinci robotassisted and thoracoscopic segmentectomy in the treatment of early-stage non-small cell lung cancer

Objective:To evaluate the clinical value of robot-assisted segmentectomy by comparing the perioperative data of patients underwent Da Vinci robot-assisted and thoracoscopic segmentectomy.Methods:Clinical data of 68 patients who underwent robot-assisted segmentectomy(robotic group)and 49 patients who underwent thoracoscopic segmentectomy(thoracoscopy group)at the Department of Thoracic Surgery,the First Affiliated Hospital of Zhengzhou University from December 2018 to February 2020 were retrospectively analyzed.The types of lung segmentectomy,postoperative pain score,hospitalization costs,operative time,intraoperative blood loss,number and groups of lymph node dissection,postoperative hospitalization time,retention time of chest drainage tube,total drainage volume and postoperative complications of the two groups were compared to determine the different clinical effectiveness of the two approaches.Results:The robotic group showed lower postoperative pain scores than the thoracoscopy group(1.94±0.64)Vs(2.29±0.65),P<0.05].The N1 lymph nodes dissection were different on groups1(IQR 1 to 2)Vs 2(IQR 1 to 3),P=0.002]and amount2(IQR 1 to 3)Vs 3(IQR 1 to 4),P=0.014]and the robotic group was superior to the thoracoscopy group,but the hospitalization cost of robotic group was higher than that in the thoracoscopy group80815.00(47914.79 to 113023.66)CNY Vs 98213.41(65302.90 to 155561.88)CNY,P<0.05].Conclusion:Robotassisted and thoracoscopic segmentectomy are safe and feasible in treating early-stage non-small cell lung cancer.Robotic approach may lead to a better N1 lymph node dissection.