8 年机器人胸腺切除术治疗胸腺瘤经验。
8 years' experience with robotic thymectomy for thymomas.
出版信息
Surg Endosc. 2014 Apr;28(4):1202-8. doi: 10.1007/s00464-013-3309-5.
BACKGROUND
The accuracy of a three-dimensional robotic-assisted videothoracoscopic approach may favor a radical resection of thymomas. The aim of this study was to demonstrate the feasibility of the robotic approach by reporting 8 years experience in a single referral center of surgical treatment of thymomas.
METHODS
We retrospectively analyzed all consecutive patients who underwent a thymectomy from April 2004 to April 2012. We analyzed the procedure time, morbidity, mortality, conversions, hospitalization, freedom from recurrence, time to progression, and overall survival.
RESULTS
From 2004 until 2012, a total of 138 robotic procedures for mediastinal tumors were performed in our center, of which 37 patients with a mean age of 57.3 years underwent a thymectomy for a thymoma. Histological analysis revealed four type A thymomas (10.8 %), seven type AB thymomas (18.9 %), seven type B1 thymomas (18.9 %), fourteen type B2 thymomas (37.8 %), four type B3 thymomas (10.8 %), and one thymus carcinoma (2.7 %). The Masaoka–Koga stages were as follows: stage I in twenty patients (54 %), stage IIA in five patients (13.5 %), stage IIB in eight patients (21.6 %), stage III in three patients (8.1 %), and stage IVa in one patient (2.7 %). The mean overall procedure time was 149 min (range 88–353). No surgical mortality was reported, and there were no peri-operative complications. No conversions were needed for surgical complications. In three cases, a conversion to sternotomy was preferred by the surgeon because tumor invasion in greater vessels was suspected. Two patients (5.4 %) suffered from a myasthenic crisis postoperatively and required prolonged mechanical ventilation. One patient (2.7 %) underwent a procedure for a thoracic herniation 6 months following thymectomy. The median hospitalization was 3 days. The follow-up analysis showed an overall survival of 100 % and tumor recurrence in one patient (2.7 %).
CONCLUSIONS
Robotic thymectomies are safe in patients with early-stage thymomas. Robotic surgery may also be feasible for some selected advanced thymomas.
背景
三维机器人辅助电视胸腔镜手术的准确性可能有利于胸腺瘤的根治性切除。本研究的目的是通过报告单中心 8 年胸腺瘤外科治疗经验来证明机器人手术的可行性。
方法
我们回顾性分析了 2004 年 4 月至 2012 年 4 月期间连续接受胸腺瘤切除术的所有患者。我们分析了手术时间、发病率、死亡率、中转、住院时间、无复发生存率、疾病进展时间和总生存率。
结果
2004 年至 2012 年期间，我院共完成 138 例纵隔肿瘤机器人手术，其中 37 例平均年龄 57.3 岁的患者因胸腺瘤行胸腺切除术。组织学分析显示 4 例 A 型胸腺瘤（10.8%）、7 例 AB 型胸腺瘤（18.9%）、7 例 B1 型胸腺瘤（18.9%）、14 例 B2 型胸腺瘤（37.8%）、4 例 B3 型胸腺瘤（10.8%）和 1 例胸腺癌（2.7%）。Masaoka-Koga 分期如下：Ⅱ期 20 例（54%），ⅡB 期 5 例（13.5%），Ⅲ期 8 例（21.6%），Ⅳa 期 3 例（8.1%）。手术总时间为 149 分钟（88-353 分钟）。无手术死亡，无围手术期并发症。无中转开胸处理手术并发症。由于怀疑肿瘤侵犯大血管，3 例中转开胸。术后 2 例（5.4%）患者发生肌无力危象，需长时间机械通气。1 例（2.7%）患者术后 6 个月发生胸腔疝。中位住院时间为 3 天。随访分析显示总生存率为 100%，1 例患者（2.7%）复发。
结论
机器人胸腺切除术治疗早期胸腺瘤是安全的。机器人手术对于某些选择的晚期胸腺瘤也可能是可行的。
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