不同体重指数范围患者行机器人辅助与电视辅助胸腔镜手术治疗纵隔肿物的围手术期结局比较：一项基于人群的研究

Comparison of perioperative outcomes between robotic-assisted and video-assisted thoracoscopic surgery for mediastinal masses in patients with different body mass index ranges: A population-based study.

作者信息

Li Rongyang, Ma Zheng, Qu Chenghao, Qiu Jianhao, Wang Kun, Yue Weiming, Tian Hui

机构信息

Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China.

出版信息

Front Surg. 2022 Jul 14;9:963335. doi: 10.3389/fsurg.2022.963335. eCollection 2022.

DOI:10.3389/fsurg.2022.963335

PMID:35910463

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9329668/

Abstract

BACKGROUND

The effectiveness of robotic-assisted thoracoscopic surgery (RATS) for mediastinal masses has not been fully evaluated. This study aimed to compare the perioperative outcomes between RATS and video-assisted thoracoscopic surgery (VATS) for mediastinal masses, and then explore which group of people would benefit more from RATS.

METHODS

This retrospective study compared the perioperative outcomes of patients with mediastinal masses who underwent RATS and VATS from September 2018 to December 2021. Subgroup analysis were performed according to body mass index (BMI) ranges.

RESULTS

A total of 212 patients with mediastinal masses (106 RATS cases and 106 VATS cases) were included. Compared with the VATS group, the RATS group had a significantly reduced incidence of overall postoperative complications (5.7% vs. 14.2%, = 0.039), complications of grade II or less (3.8% vs. 12.3%, = 0.023), and pneumonia (2.8% vs. 9.4%, = 0.045). Hospitalization costs were significantly higher in the RATS group (¥ 49350.0 vs. ¥ 32551.9, < 0.001). There was no significant difference in operation duration, intraoperative estimated blood loss, postoperative chest tube drainage volume, NRS pain score, day of chest tube removal, complications of grade III or more, or in-hospital mortality rate ( > 0.05). Subgroup analysis indicated that the incidence of overall postoperative complications (3.1% vs. 15.2%, = 0.017), complications of grade II or less (1.5% vs. 12.1%, = 0.033) and postoperative length of stay (4 days vs. 4.5 days, = 0.046) were significantly reduced in the RATS group for overweight and obese patients (BMI ≥ 24 kg/m), while these differences became insignificant in the BMI < 24 kg/m subgroup.

CONCLUSION

RATS could reduce the incidence of postoperative complications, shorten the postoperative length of stay and might be a more cost-effective surgical treatment for overweight and obese patients with mediastinal masses.

摘要

背景

机器人辅助胸腔镜手术（RATS）治疗纵隔肿物的有效性尚未得到充分评估。本研究旨在比较RATS与电视辅助胸腔镜手术（VATS）治疗纵隔肿物的围手术期结局，进而探讨哪类人群能从RATS中获益更多。

方法

本回顾性研究比较了2018年9月至2021年12月期间接受RATS和VATS治疗的纵隔肿物患者的围手术期结局。根据体重指数（BMI）范围进行亚组分析。

结果

共纳入212例纵隔肿物患者（106例RATS病例和106例VATS病例）。与VATS组相比，RATS组术后总体并发症发生率显著降低（5.7%对14.2%，P = 0.039），二级及以下并发症发生率（3.8%对12.3%，P = 0.023），以及肺炎发生率（2.8%对9.4%，P = 0.045）。RATS组的住院费用显著更高（49350.0元对32551.9元，P < 0.001）。手术时长、术中估计失血量、术后胸腔闭式引流量、NRS疼痛评分、胸腔闭式引流管拔除天数、三级及以上并发症或住院死亡率方面无显著差异（P > 0.05）。亚组分析表明，对于超重和肥胖患者（BMI≥24kg/m²），RATS组术后总体并发症发生率（3.1%对15.2%，P = 0.017）、二级及以下并发症发生率（1.5%对12.1%，P = 0.033）及术后住院时长（4天对4.5天，P = 0.046）显著降低，而在BMI < 24kg/m²亚组中这些差异不显著。