Evaluation Of Short-term Curative Effect Of Da Vinci Robot,Thoracoscope And Thoracotomy In Treating Mediastinal Tumor

Objective:To analyze and evaluate the short-term clinical efficacy of Da Vinci Robotic surgery Thoracoscopic surgery and Thoracotomy surgery in treatment of mediastinal tumors.Method:From June 2016 to September 2019,174 patients undergoing mediastinal tumor resection in thoracic surgery of Gansu Provincial People's Hospital were selected to collect all clinical data during their treatment.There were three groups according to the different operation of the subjects:65 cases of Da Vinci Robot group,61 cases of Thoracoscopy group and 48 cases of Thoracotomy group.To evaluate the basic clinical data of three groups of patients with mediastinal tumors in perioperative period by retrospective analysis,including sex,age,height,body weight,body mass index(BMI),tumor site,maximum tumor diameter,and the American association of anesthesiologists(ASA)anesthetic risk ratings;Clinical data on surgical treatment,including total operative time,total intraoperative blood loss,surgical incision size,postoperative thoracic drainage tube indwelling time,total thoracic drainage fluid volume,total postoperative hospitalization,total cost of surgery,postoperative complications and other aspects(including pulmonary infection,atelectasis,arrhythmia,and incision infection,etc.),postoperative 24h,48h and 72h incisional pain visual analogue score(VAS)and postoperative incisional pain score;and those involved in the 3 days postoperative review of peripheral blood infection indicators including white blood cell(WBC)count,neutrophil(NE)percentage,C-Reactive protein(CRP)and procalcitonin(PCT)level determination,etc.Results:1.There was no significant difference in sex,age,weight,height and body mass index among the three groups(P>0.05);2.There was no significant difference in the composition of the tumors in the anterior mediastinum(X~2=2.290,P=0.136),middle mediastinum(X~2=1.508,P=0.078)and posterior mediastinum(X~2=1.682,P=0.273)in the clinical data of the three groups.There was no significant difference between the patients with the largest tumor diameter in the three groups(F=2.146,P=0.156);The three groups were thymoma(X~2=1.850,P=0.274),teratoma(X~2=2.963,P=0.206),mediastinal cyst(X~2=1.728,P=0.492),neurogenic tumor(X~2=2.965,P=0.058),other types of tumor(X~2=3.028,P=0.063)There was no significant difference in overall patient composition;3.There was no significant difference in anesthetic risk scores(including grade I,II,III,IV)in the three groups of clinical data(P>0.05);4.There were significant differences in the total operative time(F=13.851,P<0.01),total intraoperative blood loss(F=55.998,P<0.01),surgical incision size(F=301.290,P<0.01),postoperative thoracic drainage tube indwelling time(F=51.541,P<0.01),total thoracic drainage fluid volume(F=54.752,P<0.01),total postoperative hospitalization(F=32.788,P<0.01),total cost of surgery(F=75.924,P<0.01)among the three groups;There were significant differences in the composition of patients with postoperative complications(X~2=7.237,P=0.022)and atelectasis(X~2=5.347,P=0.034);There was no significant difference in the composition of patients with arrhythmia(X~2=2.186,P=0.249),incisional infection(X~2=1.026,P=0.183)and other postoperative complications(X~2=2.397,P=0.109);5.There were significant differences in VAS scores of 24h(F=397.720,P<0.01),48h(F=95.798,P<0.01)and 72h(F=16.409,P<0.01)in all three groups;There were significant differences in the composition of patients:grade 0(X~2=24.528,P<0.01),grade 1(X~2=32.865,P<0.01),grade 2(X~2=27.305,P<0.01)and grade 3(X~2=44.296,P<0.01)in all three groups;6.the leukocyte(WBC)count(F=35.425,P<0.01),neutrophil(NE)percentage(F=46.152,P<0.01),C reactive protein(CRP)(F=197.140,P<0.01),procalcitonin(PCT)(F=125.427,P<0.01)were significantly different in all three groups.Conclusion:The three surgical methods can meet the requirements of surgical resection of mediastinal tumors.Da Vinci Robot has obvious advantages over Thoracoscopy and Thoracotomy in many aspects,and its clinical application is gradually increasing,but in the choice of operation mainly according to the patient's condition and will to achieve more accurate treatment;At present,with the rapid development and innovation of minimally invasive surgery,Da Vinci Robot and Thoracoscopic surgery are obviously representative,and the popularity of Thoracoscopy is more extensive,which has become the main operation mode.After the increase of economic level and recognition,the practical clinical application of Da Vinci Robot surgery will gradually reach the popularity.