目的：对比达芬奇机器人手术系统三孔与四孔入路在肺癌根治术中的围手术期疗效。方法：回顾性分析本院2016—2020 年142 例行肺癌根治术患者的临床资料。根据手术方式的不同将其分为三孔组和四孔组，74例患者行达芬奇机器人下四孔肺癌根治术（四孔组），其中男40 例、女34 例；68 例患者行达芬奇机器人下三孔肺癌根治术（三孔组），其中男38 例、女30 例。比较两组患者的临床资料。结果：与常规四孔入路相比，三孔入路组的手术时间长[（223.456±16.25）min Vs （192.635±19.92）min，P<0.001]，术后卧床时间短[（3.544±0.76）d Vs （4.014±0.78）d，P<0.001]，术后3d 引流量少[（194.118±62.16）ml Vs （264.189±81.79）ml，P<0.001]，术后带管时间短[（3.882±0.68）d Vs （4.338±0.81）d，P<0.001]，术后住院时间短[（5.162±0.68）d Vs （5.703±0.85）d，P<0.001] 以及术后第3d 疼痛视觉模拟评分更低[（2.794±0.98） Vs （3.297±0.96），P=0.003]；而两组在术中出血量、淋巴结清扫个数、术后并发症等方面差异无统计学意义（P>0.05）。结论：机器人辅助肺叶切除术安全有效，三孔入路在术后卧床时间、术后带管时间、术后引流、术后疼痛评分、术后快速恢复方面有明显优势，值得在熟练掌握常规四孔达芬奇机器人手术的医院进行推广。

Objective: To compare the perioperative effect of three-port and four-port Da Vinci robot-assisted radical resection for lung cancer. Methods: The clinical data of 142 patients who underwent robot-assisted radical resection of lung cancer in our hospital from 2016 to 2020 were analyzed retrospectively. The 142 patients were divided into the three-port group and the four-port group according to different surgical approaches. Among which, 74 patients were divided into the fourport group with 40 males and 34 females, and 68 patients into the three-port group with 38 males and 30 females. Results:Compared with the four-port group, the three-port group had longer operative time [(223.456 ±16.25) min Vs (192.635±19.92)min, P<0.001], shorter time in bed after surgery [(3.544±0.76) d Vs (4.014 ±0.78) d, P<0.001], less drainage volume after surgery [(194.118±62.16) ml Vs (264.189±81.79)ml, P<0.001)], shorter tube-retaining time after surgery[(3.882±0.68)d Vs 4.338±0.81)d, P<0.001)], shorter length of hospital stay [(5.162±0.68)d Vs 5.703±0.85)d, P< 0.001)], and lower visual analog scale (VAS) score on the 3rd day after surgery[(2.794±0.98) Vs (3.297±0.96mol), P=0.003]. There was no significant difference on intraoperative blood loss, number of lymph node dissection and postoperative complications between the two groups (P>0.05).Conclusion: Robot-assisted lobectomy is safe and effective. The three-port robot-assisted radical resection for lung cancer has obvious advantages on postoperative time in bed, tube-retaining time after surgery, postoperative drainage volume, postoperative pain score, postoperative recovery over the four-port approach, which is worth of promotion in hospitals with sufficient experience of four-port Da Vinci robot-assisted surgery.

收稿日期：2021-12-22 录用日期：2022-03-10

Received Date: 2021-12-22 Accepted Date: 2022-03-10

基金项目：甘肃省人民医院国家级科研项目培育计划项目（19SYPYB-28）；甘肃省卫生行业科研计划项目（GSWSKY2017-56）；甘肃省科技计划项目（20JR10RA388）

Foundation Item: National Scientific Research Project Training Program (19SYPYB-28); Health Industry Research Plan Project of Gansn province（GSWSKY2017-56）; Gansu Provincial Science and Technology Planning Project（20JR10RA388）

通讯作者：苟云久，Email：gouyunjiu@163.com

Corresponding Author: GOU Yunjiu, Email: gouyunjiu@163.com

引用格式：白向豆，曾伟强，崔百强，等. 达芬奇机器人手术系统三孔与四孔入路在肺癌根治术围手术期中的疗效对比[J]. 机器人外科学杂志（中英文），2023，4（3）：214-219.

Citation: BAI X D, ZENG W Q, CUI B Q, et al. Clinical efficacy comparison of three-port and four-port Da Vinci robot-assisted radical resection for lung cancer [J]. Chinese Journal of Robotic Surgery, 2023, 4(3): 214-219.

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