Ueno Harushi, Takada Yuri, Imamura Yoshito, Okado Shoji, Nomata Yuji, Watanabe Hiroki, Nakanishi Keita, Kadomatsu Yuka, Kato Taketo, Nakamura Shota, Mizuno Tetsuya, Chen-Yoshikawa Toyofumi Fengshi
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2024 Aug;86(3):464-471. doi: 10.18999/nagjms.86.3.464.
Postoperative air leakage is the most common complication in surgery for malignant lung tumors, leading to extended hospital stays and substantial medical expenses. This study aimed to identify the incidence and characteristics of intraoperative and postoperative air leaks in both robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS), as well as the causes of persistent air leakage following RATS. We conducted a retrospective analysis of patients who underwent lung resection for malignant lung tumors at our institution from October 2018 to August 2022. We compared the incidence rates of intraoperative air leak, postoperative air leak, and persistent air leak between patients who underwent RATS and those who underwent VATS. Background factors were adjusted using propensity score matching. A subanalysis was performed to compare unexpected air leaks, defined as air leaks not observed intraoperatively but confirmed postoperatively. The study included 295 cases of RATS and 227 cases of VATS. In both the overall population and the matched group (187 cases each for RATS and VATS), RATS demonstrated a significantly higher incidence of persistent air leaks compared to VATS (11% vs 3%, p < 0.01; 9% vs 3%, p = 0.02, respectively). RATS also had a significantly higher incidence of unexpected air leaks compared with VATS (29% vs 18%, p = 0.05). Although there was no statistically significant difference in hospital stays, RATS showed a higher incidence of postoperative persistent air leaks and unexpected postoperative air leaks than VATS.
术后漏气是恶性肺肿瘤手术中最常见的并发症，会导致住院时间延长和医疗费用大幅增加。本研究旨在确定机器人辅助胸外科手术（RATS）和电视辅助胸外科手术（VATS）中术中和术后漏气的发生率及特征，以及RATS术后持续性漏气的原因。我们对2018年10月至2022年8月在我院接受恶性肺肿瘤肺切除术的患者进行了回顾性分析。我们比较了接受RATS手术和VATS手术患者的术中漏气、术后漏气和持续性漏气的发生率。使用倾向评分匹配对背景因素进行了调整。进行了一项亚分析，以比较意外漏气，即术中未观察到但术后证实的漏气。该研究包括295例RATS手术病例和227例VATS手术病例。在总体人群和匹配组（RATS和VATS各187例）中，与VATS相比，RATS的持续性漏气发生率显著更高（分别为11%对3%，p<0.01；9%对3%，p = 0.02）。与VATS相比，RATS的意外漏气发生率也显著更高（29%对18%，p = 0.05）。尽管住院时间没有统计学上的显著差异，但与VATS相比，RATS术后持续性漏气和意外术后漏气的发生率更高。
