收稿日期: 2023-12-29
网络出版日期: 2024-07-09
基金资助
湖北省自然科学基金项目(2021CFB203)
Feasibility and safety of Da Vinci robotic-assisted thoracoscopy in pediatric mediastinal tumor resection
Received date: 2023-12-29
Online published: 2024-07-09
目的 探讨达芬奇机器人辅助胸腔镜在小儿纵隔肿瘤切除术中的应用效果。 方法 选取进行纵膈肿瘤切除的80例患儿，随机分为两组，各40例。对照组采用普通胸腔镜技术，观察组应用达芬奇机器人辅助胸腔镜。对比两组围术期指标，并根据手术时间和术中出血量建立学习曲线；比较手术前和术后24 h的疼痛介质水平、应激反应指标、术后并发症；比较术后1个月的炎性因子水平，并通过儿童生活质量普适性核心量表评价患儿术前和术后1个月的生活质量。 结果 观察组和对照组的手术时间分别为（1.76 ± 0.33）和（2.82 ± 0.62）h，术中出血量分别为（49.83 ± 6.39）和（71.55 ± 8.19）mL，且观察组的术后引流时间、引流量和住院时间均低于对照组（P < 0.05）。观察组术后血清缓激肽（BK）、5-羟色胺（5-HT）、神经肽Y（NPY）、前列腺素E2（PGE2）水平分别为（8.06 ± 1.06）mg/L、（170.20 ± 13.21）ng/L、（201.82 ± 13.52）mg/L、（241.82 ± 15.32）ng/L，其疼痛介质水平、应激反应指标和炎性因子水平均低于对照组（P < 0.05）；观察组和对照组并发症总发生率分别为2.50%和20.00%，且观察组手术后的生活质量比对照组提高，差异有统计学意义（P < 0.05）。 结论 达芬奇机器人辅助胸腔镜在小儿纵隔肿瘤切除术中具有更高的可行性和安全性，值得临床推广。
刘慧芳 , 汪力 , 董璠 , 胡超群 , 陈德美 , 范丽 . 达芬奇机器人辅助胸腔镜在小儿纵隔肿瘤切除术中使用的可行性及安全性[J]. 实用医学杂志, 2024 , 40(13) : 1840 -1845 . DOI: 10.3969/j.issn.1006-5725.2024.13.013
Objective This study aims to investigate the feasibility and safety of Da Vinci robotic-assisted thoracoscopy for resecting mediastinal tumors in pediatric patients. Methods From November 2020 to June 2023， a total of 80 pediatric patients undergoing mediastinal tumor resection at Wuhan Children's Hospital were randomly assigned into two groups， with each group consisting of 40 participants. The control group underwent conventional thoracoscopy， while the observation group underwent Da Vinci robotic-assisted thoracoscopy. This study aimed to compare perioperative indicators between the two groups and establish learning curves based on surgical duration and intraoperative blood loss. Additionally， it assessed levels of pain mediators and stress response markers before surgery and at 24 hours post-surgery， as well as postoperative complications. Inflammatory marker levels were evaluated one month after surgery， and the children's quality of life was measured using the Pediatric Quality of Life Inventory （PedsQL） Generic Core Scales before surgery and one month post-surgery. Results The surgical duration for the observation group and the control group was （1.76 ± 0.33） hours and （2.82±0.62） hours， respectively， and the intraoperative blood loss was （49.83 ± 6.39） mL and （71.55 ± 8.19） mL， respectively. Furthermore， the postoperative drainage time， drainage volume， and hospital stay for the observation group were all lower than those for the control group （P < 0.05）. After surgery， the levels of BK， 5-HT， NPY， and PGE2 in the observation group were （8.06 ± 1.06） mg/L， （170.20 ± 13.21） ng/L， （201.82 ± 13.52） mg/L， and （241.82 ± 15.32） ng/L， respectively， indicating lower levels of pain mediators， stress response markers， and inflammatory factors compared to the control group （P < 0.05）. he overall incidence of complications was 2.50% in the observation group as opposed to 20.00% in the control group. Moreover， there was a statistically significant improvement in quality of life after surgery within the observation group when compared to that within the control group （P < 0.05）. Conclusion Da Vinci robotic-assisted thoracoscopy demonstrates enhanced feasibility and safety in pediatric mediastinal tumor resection， thereby justifying its clinical promotion.
Key words： Da Vinci robot; thoracoscopy; mediastinal tumor; stress response
| 1 | 王健，卢璐，周荣真，等. 前纵隔胸腺囊肿的CT诊断及定量分析在鉴别诊断中的价值［J］. 实用放射学杂志，2019，35（9）：1415-1418. doi:10.3969/j.issn.1002-1671.2019.09.009 |
| 2 | 王宁，王晓曼，贾立群. 儿童纵隔肿瘤的超声诊断价值［J］. 中国超声医学杂志，2021，37（4）：422-424. doi:10.3969/j.issn.1002-0101.2021.04.019 |
| 3 | 何中杰，韦泽，庞靖. 前纵隔肿瘤手术治疗方式的比较［J］. 中华实验外科杂志，2020，37（6）：1162-1163. doi:10.3760/cma.j.cn421213-20191125-01498 |
| 4 | 刘瑶，吴雄伟，段于河，等. 计算机辅助手术系统在小儿纵隔肿瘤精准手术中的应用［J］. 中华实用儿科临床杂志，2022，37（22）：1750-1755. doi:10.3760/cma.j.cn101070-20220519-00575 |
| 5 | ?ZGUNER O， SHKURTI T， HUANG S， et al. Camera-Robot Calibration for the da Vinci? Robotic Surgery System［J］. IEEE Trans Autom Sci Eng， 2020， 17（4）：2154-2161. doi:10.1109/tase.2020.2986503 |
| 6 | ZENG Q， CHEN C， ZHANG N，et al. Robot-assisted thoracoscopic surgery for mediastinal tumours in children： a single-centre retrospective study of 149 patients［J］. Eur J Cardiothorac Surg， 2023， 64（5）：ezad362. doi:10.1093/ejcts/ezad362 |
| 7 | 中国抗癌协会肿瘤介入学专业委员会，中国抗癌协会肿瘤介入学专业委员会青年委员会.胸部肿瘤经皮穿刺活检中国专家共识［J］. 中华医学杂志，2018，98（23）：1822-1831. doi:10.3760/cma.j.issn.0376-2491.2018.23.004 |
| 8 | MELESSE T G， CHAU J P C， LI W H C，et al. Translation and evaluation of psychometric properties of the Amharic pediatric quality of life inventory 4.0 generic core scale for children with cancer［J］. Health Qual Life Outcomes， 2023， 21（1）：10. doi:10.1186/s12955-022-02077-8 |
| 9 | 刘馨，李星寰，左云霞. 患儿后纵隔巨大肿瘤全麻术中纵隔肿瘤综合征加重一例［J］. 临床麻醉学杂志，2018，34（11）：1142-1143. doi:10.12089/jca.2018.11.026 |
| 10 | HARRIS C J， HELENOWSKI I， MURPHY A J，et al. Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children With Chest Wall Sarcoma： A Pediatric Surgical Oncology Research Collaborative Study［J］. Ann Surg， 2022， 276（6）：e969-e975. doi:10.1097/sla.0000000000004579 |
| 11 | SALTSMAN J A， DANZER E， HAMMOND W J，et al. Survival and Scoliosis Following Resection of Chest Wall Tumors in Children and Adolescents： A Single-center Retrospective Analysis［J］. Ann Surg， 2021， 274（2）：e167-e173. doi:10.1097/sla.0000000000003495 |
| 12 | HONG Z， BAI X， SHENG Y，et al. Efficacy of using Maryland forceps versus electrocoagulation hooks in da Vinci robot-assisted thoracoscopic mediastinal tumor resection［J］. World J Surg Oncol， 2023， 21（1）：184. doi:10.1186/s12957-023-03065-y |
| 13 | JIN D， DAI Q， HAN S，et al. Effect of da Vinci robot-assisted versus traditional thoracoscopic bronchial sleeve lobectomy［J］. Asian J Surg， 2023， 46（10）：4191-4195. doi:10.1016/j.asjsur.2022.11.029 |
| 14 | 洪子强，盛燕楠，白向豆，等. 达芬奇机器人辅助经剑突下与经侧胸入路治疗前纵隔肿瘤的临床疗效比较［J］. 肿瘤防治研究，2023，50（6）：598-602. doi:10.3971/j.issn.1000-8578.2023.22.1388 |
| 15 | CHEN S， LIN Y， XU D，et al. Da vinci robotic-assisted treatment of pediatric choledochal cyst［J］. Front Pediatr， 2022， 10：1044309. doi:10.3389/fped.2022.1044309 |
| 16 | FENG Z， SUN Z， ZHANG Q，et al. Analysis of clinical efficacy and safety of hand-sewn anastomosis for the digestive tract with Da Vinci robot in rectal cancer surgery［J］. World J Surg Oncol， 2023， 21（1）：317. doi:10.1186/s12957-023-03172-w |
| 17 | YANG G， YAO P， MA S， et al. Bradykinin Activates the Bradykinin B2 Receptor to Ameliorate Neuronal Injury in a Rat Model of Spinal Cord Ischemia-Reperfusion Injury［J］. ACS Chem Neurosci， 2021， 12（6）：1031-1038. doi:10.1021/acschemneuro.1c00054 |
| 18 | BHATT S， DEVADOSS T， MANJULA S N， et al. 5-HT3 receptor antagonism a potential therapeutic approach for the treatment of depression and other disorders［J］. Curr Neuropharmacol， 2021， 19（9）：1545-1559. doi:10.2174/1570159x18666201015155816 |
| 19 | BLICHFELDT-ECKHARDT M R， OLSEN D A， ANDERSEN R F， et al. Elevated Levels of PGE2-Metabolite in Cerebrospinal Fluid and Cox-2 Gene Polymorphisms in Patients with Chronic， Post Cholecystectomy Pain and Visceral Hyperalgesia Compared to Healthy Controls. A Hypothesis-Generating Pilot Study［J］. J Pain Res，2022， 15：3921-3929. doi:10.2147/jpr.s387502 |
| 20 | HONG Z， CUI B， SHENG Y，et al. Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients： A propensity score matching study［J］. J Surg Oncol， 2023， 128（4）：667-674. doi:10.1002/jso.27312 |
| 21 | ABE T， KOMORI A， SHIRAISHI A， et al. Trauma complications and in-hospital mortality： failure-to-rescue［J］. Crit Care， 2020， 24（1）：223. doi:10.1186/s13054-020-02951-1 |
| 22 | PARK S H， KIM Y N， HWANG J， et al. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer： a phase I/II clinical trial using the da Vinci Single Port（SP） robotic system［J］. Sci Rep， 2023， 13（1）：18578. doi:10.1038/s41598-023-45655-6 |
| 23 | KAN H C， PANG S T， WU C T， et al. Robot-assisted laparoendoscopic single site adrenalectomy： A comparison of 3 different port platforms with 3 case reports［J］. Medicine （Baltimore）， 2017， 96（51）：e9479. doi:10.1097/MD.0000000000009479 |
| 24 | KUMARI M， MATHUR P， AGGARWAL R，et al. Changes in extracellular cytokines in predicting disease severity and final clinical outcome of patients with blunt chest trauma［J］. Immunobiology， 2021，226（3）：152087. doi:10.1016/j.imbio.2021.152087 |
/
| 〈 |
|
〉 |