三种早期胸腺瘤治疗方法的比较：机器人辅助胸外科手术、电视辅助胸外科手术和正中胸骨切开术。
A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy.
作者信息
Qian Liqiang, Chen Xiaoke, Huang Jia, Lin Hao, Mao Feng, Zhao Xiaojing, Luo Qingquan, Ding Zhengping
机构信息
Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China.
Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China.
出版信息
J Thorac Dis. 2017 Jul;9(7):1997-2005. doi: 10.21037/jtd.2017.06.09.
BACKGROUND
This aim of this study was to compare three approaches of extended thymectomy for the treatment of early-stage thymomas, which included robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and median sternotomy (MS) perioperative parameters.
METHODS
A retrospective study was conducted on 123 patients with early stage thymomas at Shanghai Chest Hospital who underwent extended thymectomy between February 2009 and August 2014. Among them, MS was performed on 37 patients, VATS was performed on 35 patients, and RATS was performed on 51 patients. A series of outcome measures were compared between these three approaches, including operative time, intra-operative blood loss volume, occurrence of intra-operative complications, post-operative pleural drainage duration, post-operative pleural drainage volume, duration of hospital stay, and the incidence of post-operative complications.
RESULTS
A series of intra- and post-operative parameters showed significant differences in intra-operative blood loss volume, mean post-operative pleural drainage duration, pleural drainage volume and mean duration of hospital stay. For these parameters, during further analysis, significant differences were also demonstrated for comparisons between any two groups. RATS reduces the post-operative drainage duration and volume (2.88 3.77 and 4.41 days, P<0.05; 352.2 613.9 and 980 mL, P<0.05) and the hospital stay versus the MS and VATS groups (4.3 5.5 and 6.6 days). Three patients experienced post-operative complications in the MS group, and no post-operative complications occurred in the RATS or VATS group.
CONCLUSIONS
RATS and VATS both appear feasible and safe for the resection of early-stage thymomas as compared to MS. RATS is less invasive than VATS with a shorter post-operative pleural drainage duration time, a reduced drainage volume, and a shorter hospital stay.
背景
本研究旨在比较三种扩大胸腺切除术治疗早期胸腺瘤的方法，包括机器人辅助胸外科手术（RATS）、电视辅助胸外科手术（VATS）和正中胸骨切开术（MS）的围手术期参数。
方法
对2009年2月至2014年8月在上海胸科医院接受扩大胸腺切除术的123例早期胸腺瘤患者进行回顾性研究。其中，37例患者接受MS手术，35例患者接受VATS手术，51例患者接受RATS手术。比较这三种方法的一系列结局指标，包括手术时间、术中失血量、术中并发症发生率、术后胸腔引流持续时间、术后胸腔引流量、住院时间以及术后并发症发生率。
结果
一系列术中及术后参数在术中失血量、术后平均胸腔引流持续时间、胸腔引流量和平均住院时间方面存在显著差异。对于这些参数，在进一步分析中，任意两组之间的比较也显示出显著差异。与MS组和VATS组相比，RATS可减少术后引流持续时间和引流量（分别为2.88±3.77天和4.41天，P<0.05；352.2±613.9毫升和980毫升，P<0.05）以及住院时间（分别为4.3±5.5天和6.6天）。MS组有3例患者发生术后并发症，RATS组或VATS组未发生术后并发症。
结论
与MS相比，RATS和VATS用于早期胸腺瘤切除似乎都是可行且安全的。RATS的侵入性小于VATS，术后胸腔引流持续时间更短，引流量减少，住院时间更短。
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