摘要
目的总结达芬奇机器人手术系统(DVSS)在661例普胸外科手术中应用的临床经验。方法回顾性分析自2011年3月至2016年2月沈阳军区总医院胸外科应用DVSS对661例患者进行胸外科手术的临床资料。整个手术过程分为:(1)诱导麻醉;(2)摆体位,设计Trocar分布、安装机械臂(有些病变部位在摆体位前需要CT引导下定位);(3)寻找病变部位、进行手术治疗。根据患者病变部位所设计的手术部位及切口位置设计胸外科Trocar排布,总结我科不同病变部位的Trocar位置选择、手术入路选择、相关术中与术后情况及并发症治疗的经验体会。结果本组共661例患者,包括372例肺部手术,286例纵膈手术和3例食管手术。肺部手术设计了"8857"孔法手术入路,70/372例需要术前定位;60/372例胸腔内重度粘连,但顺利完成DVSS手术,未转成开胸手术。纵膈手术(包括心包囊肿或占位)设计4种手术入路,45/286例术中、术后未留置引流管。3例食管手术主要是食管壁内肿物。6/661例患者术后出现乳糜胸,1例为纵膈术后,5例为肺部术后。经保守治疗后,4/6例痊愈,1/6例再次行DVSS手术治疗(经左胸乳糜胸清除,胸导管结扎术),1/6例死亡。其中,1/655例患者术后因出现心梗死亡(术后1 h内);1/661例术中出现大出血,均并转为开胸手术治疗。78/655例患者(除外乳糜胸患者)术后引流管带管时间过长(带管超过5 d),无其他严重并发症。结论总体来说,DVSS在胸外科手术中的应用是安全、有效的,人工气胸的建立、患者自身的耐受性、第一个Trocar位置的选择及胸腔里粘连的情况,对手术成功与否起重要作用。
Objective To explore the clinical effect of general thoracic surgery with da Vinci robotic surgical system（ DVSS） in661 patients. Methods A retrospective study was performed on 661 cases of patients that received operations using DVSS from March2011 to February 2016. The whole operation process was divided into three steps. Firstly,induction ofanesthesia. Secondly,setting bodyposition,distribution of trocars and installation of the mechanical arms（ some lesions of the patients needed the position under the guidance of CT scanning before setting body position）. Thirdly,to find the lesion site and give surgical treatment. The distribution of trocars was designed according to the surgical sites and location of the incision. The clinical experience in trocars placement,surgicalapproach,intra-operation and post operation states and management of complications were summarized and explored. Results All the patients that received operations using DVSS. Totally 372 cases of lung surgeries designed ＂8857 ＂holes method of surgical approach and 70 cases needed preoperative localization under the guidance of CT scanning. And 60 cases of severe pleural adhesion had successful received the operation with DVSS. They did not turn into the thoracotomy. All 286 cases received operations of mediastinal tumors（ containing pericardial cyst and mass）. Four surgical approaches were designed according to the different tumorssites of the mediastina. There were 45 cases with mediastinal tumor underwent resection with DVSS without a chest tube insertion after operation.Three cases of esophageal surgery were mainly the tumor of the esophagus wall. After operations via DVSS,six cases got chylothorax.One case was the resection of posterior mediastinalcyst,others were the lung operations. Four cases were cured with conservative treatment,one case had second operation again（ through the left chest to remove chylothorax and thoracic duct ligation with Da Vinci robotic surgical system） and one case died. There were three cases
出处
《临床军医杂志》
CAS
2016年第6期556-562,共7页
Clinical Journal of Medical Officers
基金
辽宁省科技厅重点课题(面上项目)(2015020431)
关键词
达芬奇机器人手术系统
胸外科
手术入路
da Vinci robotic surgical system
Thoracic surgery
Surgical approach
