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

doi:10.3969/j.issn.1006-5725.2024.13.013

Abstract

Abstract:

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

CLC Number:

R734.5

Huifang LIU,Li WANG,Fan DONG,Chaoqun HU,Demei CHEN,Li. FAN. Feasibility and safety of Da Vinci robotic-assisted thoracoscopy in pediatric mediastinal tumor resection[J]. The Journal of Practical Medicine, 2024, 40(13): 1840-1845.

Figures/Tables 11

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References 24

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组别	对照组（n = 40）	观察组（n = 40）	t/χ ² 值	P值
性别（例）			0.464	0.496
男	22	25
女	18	15
年龄（岁）	5.81 ± 2.24	5.47 ± 2.08	0.703	0.484
体质量（kg）	25.71 ± 5.82	25.33 ± 5.29	0.306	0.761
肿瘤直径（cm）	3.94 ± 1.37	3.78 ± 1.22	0.552	0.583
术后病理结果（例）			0.456	0.796
胸腺囊肿	9	8
胸腺增生	14	12
胸腺瘤	17	20

组别	例数	手术时间（h）	术中出血量（mL）	术后引流时间（d）	术后引流量（L）	住院时间（d）
观察组	40	1.76 ± 0.33	49.83 ± 6.39	2.98 ± 0.52	1.42 ± 0.22	6.02 ± 0.86
对照组	40	2.82 ± 0.62	71.55 ± 8.19	4.91 ± 0.71	1.79 ± 0.34	7.36 ± 1.03
t值		9.545	13.224	13.870	5.778	12.679
P值		< 0.05	< 0.05	< 0.05	< 0.05	< 0.05

指标	组别	方程	R² 值
手术时间	对照组	y=4.505-0.611*log（x）	0.741
	观察组	y=2.708-0.344*log（x）	0.815
术中出血量	对照组	y=94.619-8.364*log（x）	0.796
	观察组	y=68.527-6.779*log（x）	0.858

组别	例数	BK（mg/L）		5-HT（ng/L）		NPY（mg/L）		PGE2（ng/L）
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
观察组	40	5.63 ± 1.13	8.06 ± 1.06^*	154.12 ± 12.36	170.20 ± 13.21^*	172.15 ± 20.58	201.82 ± 13.52^*	134.40 ± 9.25	241.82 ± 15.32^*
对照组	40	5.51 ± 1.09	11.33 ± 1.15^*	153.81 ± 12.21	198.92 ± 16.28^*	175.06 ± 25.69	238.23 ± 15.11^*	135.52 ± 9.68	267.35 ± 16.16^*
t值		0.483	13.223	0.113	8.664	0.559	11.357	0.529	7.251
P值		0.630	< 0.05	0.910	< 0.05	0.578	< 0.05	0.598	< 0.05

组别	例数	Cor（mmol/L）		ACTH（ng/dL）		Ang-Ⅱ（ng/dL）
组别	例数	术前	术后	术前	术后	术前	术后
观察组	40	225.34 ± 26.57	248.43 ± 19.74^*	3.66 ± 1.01	4.12 ± 0.82	34.18 ± 5.52	48.59 ± 4.21^*
对照组	40	219.89 ± 25.24	275.36 ± 20.37^*	3.59 ± 1.06	6.88 ± 1.03^*	34.72 ± 5.36	56.05 ± 4.93^*
t值		0.751	6.004	0.302	13.259	0.444	7.278
P值		0.455	< 0.05	0.763	< 0.05	0.658	< 0.05

Feasibility and safety of Da Vinci robotic-assisted thoracoscopy in pediatric mediastinal tumor resection

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组别	例数	发热	肺不张	切口液化	胸腔积液	总发生率
观察组	40	1（2.50）	0（0.00）	0（0.00）	0（0.00）	1（2.50）
对照组	40	3（7.50）	2（5.00）	2（5.00）	1（2.50）	8（20.00）
χ² 值						6.135
P值						< 0.05

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组别	例数	TNF-α		IL-4		IL-6		IL-8
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
观察组	40	73.01 ± 7.26	60.12 ± 5.11^*	7.20 ± 2.52	3.42 ± 0.57^*	420.71 ± 23.52	189.40 ± 15.22^*	826.12 ± 36.69	531.71 ± 29.11^*
对照组	40	73.42 ± 7.41	66.93 ± 5.23^*	7.34 ± 2.57	5.87 ± 0.82^*	418.36 ± 20.63	265.28 ± 21.36^*	830.24 ± 38.93	683.05 ± 32.63^*
t值		0.250	5.890	0.246	15.516	0.475	18.298	0.487	21.889
P值		0.803	< 0.05	0.806	< 0.05	0.636	< 0.05	0.628	< 0.05

组别	例数	生理功能		情感功能		社交功能		学校表现
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
观察组	40	60.85 ± 8.23	82.11 ± 7.23^*	59.15 ± 7.12	74.38 ± 7.12^*	60.82 ± 8.03	78.25 ± 7.05^*	57.16 ± 6.12	76.28 ± 7.16^*
对照组	40	61.10 ± 8.45	72.79 ± 6.05^*	59.93 ± 7.26	65.36 ± 6.29^*	60.41 ± 8.16	69.13 ± 6.37^*	56.92 ± 6.20	65.19 ± 6.39^*
t值		0.134	6.253	0.485	6.005	0.226	6.071	0.174	7.309
P值		0.894	< 0.05	0.629	< 0.05	0.821	< 0.05	0.862	< 0.05