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目的:总结da Vinci S手术机器人胸腺瘤切除术的临床经验。方法:自2009年5月～2009年10月解放军第二炮兵总医院用da Vinci S手术机器人切除胸腺瘤3例,根据胸腺瘤体偏向一侧作为手术入路一侧。患者仰卧位,将术侧胸部及肩部垫高30度。双腔气管插管,手术对侧肺单肺通气,从患者头侧偏向非术侧约30度将床旁机械臂车推至手术台旁合适位置,选定术侧胸壁腋前线至腋中线间第6肋间作为内窥镜成像系统入口,戳孔放入戳卡,并于其左右侧各一拳的距离(约在锁骨中线外第3肋间和第5肋间或第6肋间)插入左右机械手臂。于内窥镜戳孔与左操作孔之间向后加一个辅助孔。切除瘤体和全部胸腺,并清除其周围脂肪组织,胸腺周围小血管均用电凝止血,胸腺静脉用钛夹夹闭,标本用取物袋取出。结果:所有3例患者均手术成功,无手术死亡及主要并发症。无中转开胸,未加小切口。均完整切除瘤体和胸腺,并清除胸腺周围脂肪组织。手术时间80～240min(平均136.7min)。术后16～49h(平均28.7h)时拔除气管插管,术中估计出血量30～100mL(平均63.3mL),术后24h胸管引流量为100～250mL(平均160mL),围术期均未输血。1例左侧进胸者一过性膈神经麻痹,出院时复查恢复正常。术后病理按WHO分型,2例为B1型胸腺瘤,1例为B2型。结论:本研究报告的用da Vinci S手术机器人进行胸腺瘤切除术及周围脂肪组织清除是可行的,早期效果满意。
Objective: To summarize the clinical experience of da Vinci S surgical thymoma excision. Methods: From May 2009 to October 2009, the Second Artillery General Hospital of People’s Liberation Army with da Vinci S surgical removal of thymoma in 3 cases, according to the side of the thymus body to the side as the surgical approach. Patient supine position, the operation side of the chest and shoulder pad 30 degrees. Double-lumen endotracheal intubation, surgery on the lungs of the lungs of one lung ventilation, from the patient’s head side to non-surgical side of about 30 degrees to push the bedside arm car to the appropriate position next to the operating table, select the side of the chest wall axillary line to axillary line The 6th intercostal space as the endoscopic imaging system entrance, poke holes into the poker card, and on its left and right side of each boxing distance (about clavicle and intercostal intercostal intercostal or intercostal intercostal space) Around the mechanical arm. Auxiliary holes are added backwards between the endoscopic poking hole and the left operating hole. Excision of the tumor and all the thymus, and remove the surrounding adipose tissue, small blood vessels around the thymus are electrocatalytic hemostasis, thymus vein clamp with titanium clips, specimens removed with a bag. Results: All three patients were successfully surgically treated with no operative deaths and major complications. No transfer thoracotomy, no small incision. The tumor and thymus were completely excised and the adipose tissue around the thymus was removed. Surgery time 80 ~ 240min (average 136.7min). Tracheal intubation was removed 16 to 49 hours postoperatively (mean 28.7 hours). The intraoperative blood loss was estimated to be 30-100 mL (average 63.3 mL). The drainage volume of the chest tube was 100-250 mL (average 160 mL) No blood transfusion. One case of the left chest into a transient phrenic nerve paralysis, returned to normal after discharge. Postoperative pathology by WHO classification, 2 cases of type B1 thymoma, 1 case of type B2. Conclusion: The study reported that the da Vinci S surgical robot for thymoma resection and peripheral adipose tissue clearance is feasible, the early results are satisfactory.