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达芬奇Xi机器人在单侧腋窝入路免充气甲状腺手术中的临床应用分析
Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach
- 中国癌症杂志 2023年33卷第11期 页码：1018-1025
- 作者机构：
1. 复旦大学附属肿瘤医院头颈外科，复旦大学上海医学院肿瘤学系，上海 200032
2. 复旦大学附属闵行医院普通外科，上海 201199
3. 复旦大学附属肿瘤医院手术室，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
[ "史荣亮（ORCID: 0009-0008-7831-2123），博士，副主任医师。" ]
王宇（ORCID: 0000-0003-2622-294X），博士，主任医师，复旦大学附属肿瘤医院头颈外科主任。
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2023.11.007
中图分类号： R736.1收稿：2023-06-27，
修回：2023-10-27，
纸质出版：2023-11-30
- 稿件说明：
移动端阅览
史荣亮, 张婷婷, 王宇, 等. 达芬奇Xi机器人在单侧腋窝入路免充气甲状腺手术中的临床应用分析[J]. 中国癌症杂志, 2023,33(11):1018-1025.
Rongliang SHI, Tingting ZHANG, Yu WANG, et al. Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach[J]. China Oncology, 2023, 33(11): 1018-1025.
史荣亮, 张婷婷, 王宇, 等. 达芬奇Xi机器人在单侧腋窝入路免充气甲状腺手术中的临床应用分析[J]. 中国癌症杂志, 2023,33(11):1018-1025. DOI： 10.19401/j.cnki.1007-3639.2023.11.007.
Rongliang SHI, Tingting ZHANG, Yu WANG, et al. Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach[J]. China Oncology, 2023, 33(11): 1018-1025. DOI： 10.19401/j.cnki.1007-3639.2023.11.007.
摘要
背景和目的：
2007年，Kang等第1次将机器人手术应用于甲状腺，之后机器人甲状腺手术在全球范围内开展。因安全性、肿瘤治疗的根治性和美容性不断得到验证，腋窝入路比例在国内正在快速增长。本研究通过对比分析使用达芬奇Xi机器人完成的95例单侧腋窝入路免充气甲状腺手术与91例传统手术治疗cN
0期
甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）的临床疗效，探讨达芬奇Xi机器人单侧腋窝入路手术治疗PTMC的优势及临床应用价值。
方法：
回顾性分析2020年3月—2021年11月复旦大学附属肿瘤医院头颈外科收治的186例cN
0期
单侧单灶PTMC患者的临床数据，根据手术方式分为机器人组（95例）和开放组（91例），分析比较两组患者的一般临床资料、手术结果、术后并发症、切口满意度、学习曲线及手术费用等情况。
结果：
两组患者在性别、年龄、是否合并桥本甲状腺炎、肿瘤直径及病灶位置方面差异无统计学意义（
P
>
0.05）。机器人组手术时间[（126.65±34.76）min
]
长于开放组[（60.99±21.12）min
]
，在经历36例手术后手术时间可达稳定水平。手术费用[（47 940.66±4 404.30）元
]
高于开放组[（15 807.73±2 295.35）元
]
。在术中出血量[机器人组：（20.48±18.83）mL；开放组：（16.15±13.95）mL
]
、清扫淋巴结个数[机器人组：（2.61±2.77）枚；开放组：（2.97±2.20）枚
]
和检出阳性淋巴结个数[机器人组：（1.01±1.61）枚；开放组：（0.78±1.36）枚
]
方面差异无统计学意义（
P
>
0.05）。机器人组术后暂时性声嘶（1.10%）低于开放组（2.20%），但差异无统计学意义（
P
>
0.05）。机器人组术后切口满意度（非常满意87.4%，比较满意11.6%）高于开放组（非常满意71.4%，比较满意26.4%），差异有统计学意义（
P
<
0.05）。
结论：
达芬奇Xi机器人单侧腋窝入路免充气甲状腺手术不仅具有良好的美容效果，较高的患者满意度，而且学习曲线短，术中出血量、淋巴结检测情况及术后并发症发生情况与传统手术相当。
Abstract
Background and purpose:
Robotic thyroid surgery has been carried out worldwide since Kang first applied it to the thyroid in 2007. The proportion of axillary approach is increasing rapidly in China due to the continuous verification of safety
radicalness and cosmetic properties of cancer treatment. The advantages and clinical value of Da Vinci Xi robotic unilateral axillary approach in the treatment of unilateral papillary thyroid microcarcinoma (PTMC) was investigated by comparing an
d analyzing the clinical efficacy in 95 patients undergoing a gasless
unilateral axillary approach Da Vinci Xi robotic thyroid surgery for PTMC and 91 patients undergoing conventional surgery.
Methods:
The clinical data of 186 cases of unilateral PTMC undergoing thyroidectomy in the Department of Head and Neck Surgery of Shanghai cancer Hospital from March 2020 to November 2021 were retrospectively analyzed
and they were divided into the robotic group (95 cases) and the open group (91 cases) according to the surgical methods. The general clinical data
surgical results
postoperative complications
satisfaction of incision
learning curve and surgical costs were analyzed and compared between the two groups.
Results:
There was no statistically significant difference between the two groups in gender
age
incidence of Hashimoto’s thyroiditis
tumor diameter
location and number of lesions (
P
>
0.05). However
the operation time was significantly longer in the robotic group [(126.65±34.76) min
]
than in the open group [(60.99±21.12) min
]
and after 36 operations
the operation time reached a stable level. The operation cost was significantly higher in the robotic group [(47 940.66±4 404.30) yuan
]
than in the open group [(15 807.73±2 295.35) yuan
]
. There was no significant difference in intraoperative hemorrhage [robotic group: (20.48±18.83) mL; open group: (16.15±13.95) mL
]
the number of removed lymph nodes (robotic group: 2.61±2.77; open group: 2.97±2.20) and the number of positive lymph nodes (robotic group: 1.01±1.61; open group: 0.78±1.36) between the two groups (
P
>
0.05). The incidence of postoperative temporary vocal hoarseness and transient hypocalcemia was lower in the robotic group (1.10%
2.10%
respectively) than in the open group (2.20%
3.30%
respectively)
however there was no statistically significant difference (
P
>
0.05). The postoperative satisfaction of incision was significantly higher in the robotic group (very
satisfied 87.4%
satisfied 11.6%) than in the open group (very satisfied 71.4%
satisfied 26.4%)
and the difference was statistically significant (
P
<
0.05).
Conclusion:
Da Vinci Xi robot in thyroid surgery using a gasless
unilateral axillary approach has not only good cosmetic effect and high patient satisfaction
but also short learning curve. The amount of bleeding during the surgery
the lymph node detection and the occurrence of postoperative complications are comparable to the traditional surgery.
关键词
Keywords
references
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