目的：探究接受双孔机器人手术（DRATS）和单孔胸腔镜手术（UVATS）对非小细胞肺癌患者的成本效益。方法：选取 2021 年 1 月—2022 年 10 月于青岛市市立医院接受手术的非小细胞肺癌（NSCLC）患者作为研究对象。根据手术方式的不同 将其分为 DRATS 组和 UVATS 组，利用马尔科夫决策模型，对 NSCLC 患者术后 1 年和第 2 年的疾病进展进行模拟分析，以 评估患者的医疗成本和收益，探讨 DRATS 与 UVATS 的成本效益。结果：在术后 1 年内，DRATS 组相较于 UVATS 组增加了 0.01 质量调整生命年（QALY），增量成本效益比（ICER）为 57 307.00 USD /QALY。在术后 2 年内，DRATS 组额外支付了 1720.26 USD，增加了 0.04 QALY，DRATS 组的 ICER 为 43 006.50 USD /QALY。学习曲线也对 DRATS 组的成本效益有影响。 根据山东省的支付意愿，DRATS 组不具有明显的成本效益。结论：DRATS 能使患者获得更好的生活质量，从术后 2 年随访 结果来看，接受 DRATS 的患者获益逐渐增加。此外，主刀医生丰富的手术经验和手术团队的融洽合作有助于提高 DRATS 的 成本效益。然而，DRATS 最明显的劣势是昂贵的手术费用，这导致 DRATS 在社会经济水平较发达的城市更具有成本效益。

Objective: To explore the cost-effectiveness of dual-portal robot-assisted thoracic surgery (DRATS) versus uniportal videoassisted thoracic surgery (UVATS) in patients undergoing these procedures. Methods: Patients with non-small cell lung cancer (NSCLC) who underwent surgery at Qingdao Municipal Hospital from January to and October 2022 were enrolled. They were divided into the DRATS group and the UVATS group based on different surgical approaches. A Markov decision process model was developed to simulate disease progression during the first and second year after surgery, assessing medical costs and outcomes to evaluate the cost-effectiveness of DRATS versus UVATS. Results: Within the first year after surgery, the DRATS group gained 0.01 additional quality-adjusted life years (QALYs) compared to the UVATS group, with an incremental cost-effectiveness ratio (ICER) of 57 307.00 USD/QALY. Over a twoyear postoperative period, the DRATS group incurred an incremental cost of 1720.26 USD and gained 0.04 additional QALYs, resulting in an ICER of 43 006.50 USD/QALY. The cost-effectiveness of DRATS is also influenced by the learning curve. Based on the willingnessto-pay threshold in Shandong Province, DRATS did not demonstrate significant cost-effectiveness. Conclusion: DRATS could improve patients’ quality of life, with incremental benefits over a two-year follow-up. Surgeons’ extensive experience and cohesive teamwork can enhance the cost-effectiveness of DRATS. However, the high costs of DRATS remain a critical limitation, rendering it more cost-effective in socioeconomically developed regions.

基金项目：国家自然科学基金（2204152） 

Foundation Item: National Natural Science Foundation of China(2204152) 

引用格式：王树民，李飞，褚恒，等 . 双孔机器人手术与单孔胸腔镜手术治疗非小细胞肺癌的成本效益分析 [J]. 机器人外科学杂志（中英文）， 2025，6（3）：383-387. 

Citation: WANG S M, LI F, CHU H, et al. Cost-effectiveness analysis of dual-portal robot-assisted thoracic surgery and uniportal videoassisted thoracoscopic surgery in the treatment of non-small cell lung cancer [J]. Chinese Journal of Robotic Surgery, 2025, 6(3): 383-387. 

通讯作者（Corresponding Author）：张哲（ZHANG Zhe），Email：zhang-elu@163.com

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