CAJ | 학술논문

背景与目的近年来达芬奇机器人手术系统（da Vinci robot system）应用于治疗胸内纵隔疾病日趋成熟。本研究通过总结沈阳军区总医院近3年来在纵隔疾病中行手术治疗的临床病例资料，探讨达芬奇机器人手术系统在手术中的疗效；并比较其与电视胸腔镜在纵隔手术中的优缺点，展望达芬奇机器人手术系统在纵隔手术中的应用前景。方法选择2010年1月-2013年11月沈阳军区总医院行达芬奇机器人手术及电视胸腔镜下（含胸腔镜辅助小切口）手术的胸内纵隔疾病患者共203例。对两组的手术时间、术中失血量、术后3天内引流总量、术后拔管时间、术后住院时间、手术费用进行比较，结果应用SPSS 19.0进行相关分析。结果两组共203例患者均顺利完成手术。术后恢复良好，无围手术期死亡病例。手术时间机器人组为82（20-320）min，电视胸腔镜组89（35-360） min，差异无统计学意义（P>0.05）。术中出血量：机器人组为10（1-100）mL，电视胸腔镜组50（3-1,500）mL；术后72 h引流量：机器人组215（0-2,220）mL，电视胸腔镜组350（50-1,810）mL；术后拔管时间：机器人组3（0-10） d，电视胸腔镜组5（1-18）d；术后住院天数：机器人组7（2-15）d，电视胸腔镜组9（2-50）d；手术费用：机器人组（18,983.6±4,461.2）元，电视胸腔镜组（9,351.9±2,076.3）元，以上指标两组比较差异均具有统计学意义（P<0.001）。结论达芬奇机器人手术与电视胸腔镜手术在胸内纵隔疾病的手术时间相当，在手术安全性以及术后快速恢复上均优于胸腔镜手术，但手术费用也比胸腔镜手术明显增加。
배경여목적근년래체분기궤기인수술계통（da Vinci robot system）응용우치료흉내종격질병일추성숙。본연구통과총결침양군구총의원근3년래재종격질병중행수술치료적림상병례자료，탐토체분기궤기인수술계통재수술중적료효；병비교기여전시흉강경재종격수술중적우결점，전망체분기궤기인수술계통재종격수술중적응용전경。방법선택2010년1월-2013년11월침양군구총의원행체분기궤기인수술급전시흉강경하（함흉강경보조소절구）수술적흉내종격질병환자공203례。대량조적수술시간、술중실혈량、술후3천내인류총량、술후발관시간、술후주원시간、수술비용진행비교，결과응용SPSS 19.0진행상관분석。결과량조공203례환자균순리완성수술。술후회복량호，무위수술기사망병례。수술시간궤기인조위82（20-320）min，전시흉강경조89（35-360） min，차이무통계학의의（P>0.05）。술중출혈량：궤기인조위10（1-100）mL，전시흉강경조50（3-1,500）mL；술후72 h인류량：궤기인조215（0-2,220）mL，전시흉강경조350（50-1,810）mL；술후발관시간：궤기인조3（0-10） d，전시흉강경조5（1-18）d；술후주원천수：궤기인조7（2-15）d，전시흉강경조9（2-50）d；수술비용：궤기인조（18,983.6±4,461.2）원，전시흉강경조（9,351.9±2,076.3）원，이상지표량조비교차이균구유통계학의의（P<0.001）。결론체분기궤기인수술여전시흉강경수술재흉내종격질병적수술시간상당，재수술안전성이급술후쾌속회복상균우우흉강경수술，단수술비용야비흉강경수술명현증가。
Background and objective In recent years, Da Vinci robot system applied in the treatment of intratho-racic surgery mediastinal diseases become more mature. hTe aim of this study is to summarize the clinical data about mediasti-nal lesions of General Hospital of Shenyang Military Region in the past 4 years, then to analyze the treatment effect and prom-ising applications of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods 203 cases of mediastinal lesions were collected from General Hospital of Shenyang Military Region between 2010 and 2013. hTese patients were di-vided into two groups da Vinci and video-assisted thoracoscopic surgery (VATS) according to the selection of the treatments. hTe time in surgery, intraoperative blood loss, postoperative drainage amount within three days atfer surgery, the period of bearing drainage tubes, hospital stays and hospitalization expense were then compared. Results All patients were successfully operated, the postoperative recovery is good and there is no perioperative death. hTe different of the time in surgery between two groups is Robots group 82 (20-320) min and thoracoscopic group 89 (35-360) min (P>0.05). hTe intraoperative blood loss between two groups is robot group 10 (1-100) mL and thoracoscopic group 50 (3-1,500) mL. hTe postoperative drainage amount within three days atfer surgery between two groups is robot group 215 (0-2,220) mL and thoracoscopic group 350 (50-1,810) mL. hTe period of bearing drainage tubes atfer surgery between two groups is robot group 3 (0-10) d and thora-coscopic group:5 (1-18) d. hTe difference of hospital stays between two groups is robot group 7 (2-15) d and thoracoscopic group 9 (2-50) d. hTe hospitalization expense between two groups is robot group (18,983.6±4,461.2) RMB and thoracoscopic group (9,351.9±2,076.3) RMB (All P<0.001). Conclusion hTe da Vinci robot system is safe and effcient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach, even though its expense is higher.