526例胸腔镜与机器人前纵隔肿物切除术的比较：一项回顾性分析研究

Comparison of Thoracoscopic and Robotic Anterior Mediastinal Tumor Resection in 526 Patients: A Retrospective Analysis

摘要: 背景：前纵隔肿物微创手术方式及手术入路有多种，尚无标准手术方式。目的：通过分析比较胸腔镜与机器人前纵隔肿物切除术的观测指标差异，为临床手术选择提供参考。方法：收集2018年1月至2022年10月就诊于本医院行微创手术治疗前纵隔肿物的患者各项资料，根据手术方式分为胸腔镜手术组(406例)与机器人手术组(120例)，对比两组的手术时长、出血量、引流管放置时间、引流量、术后疼痛视觉模拟评分(visual analogue score, VAS)、术后住院时间及围术期并发症的差异。结果：两组患者全部顺利完成手术康复出院，无围术期死亡等严重并发症。对两组患者观测指标进行比较分析，两组患者在手术时长、带管时间、术后24 h VAS评分、围术期并发症及病理类型无统计学差异(p > 0.05)，在术中出血量、胸腔引流量、术后住院时间、联合肺部或心包手术及肿物直径存在统计学差异(p < 0.05)。结论：胸腔镜、机器人手术是治疗前纵隔肿物的安全有效的方法，且机器人手术围术期效果、安全性优于胸腔镜手术。

Abstract: Background: There are many minimally invasive surgical methods and surgical approaches for an-terior mediastinal tumors, and there is no standard surgical method. Purpose: By analyzing and comparing the differences of observation indexes between thoracoscopic and robotic anterior me-diastinal tumor resection, it provides a reference for clinical surgical selection. Method: The data of patients who underwent minimally invasive surgery for anterior mediastinal masses in our hospital from January 2018 to October 2022 were collected. According to the surgical methods, they were divided into thoracoscopic surgery group (406 cases) and robotic surgery group (120 cases). The operation time, blood loss, drainage tube placement time, drainage volume, postoperative pain visual analogue score, hospitalization time and complications were compared between the two groups. Result: All patients in the two groups successfully completed the operation and were dis-charged without serious complications such as perioperative death. The observation indexes of the two groups were compared. There was no statistical difference between the two groups in the length of operation, the time of catheterization, the VAS score at 24 h after operation, the perioper-ative complications and the pathological types (p > 0.05). There were statistical differences in in-traoperative blood loss, thoracic drainage, postoperative hospital stay, combined lung or pericardial surgery and tumor diameter (p < 0.05). Conclusion: Thoracoscopic and robotic surgery are safe and effective methods for the treatment of anterior mediastinal masses, and the perioperative effect and safety of robotic surgery are better than thoracoscopic surgery.