摘要
目的总结机器人手术系统在先天性心脏病矫正术中应用的临床经验。方法回顾性分析2007年1月至2012年5月解放军总医院心血管外科160例接受机器人辅助下、先天性心脏病（简称先心病）矫正术患者的临床资料，其中男74例，女86例；年龄11～62（35±12）岁。继发孔型房间隔缺损130例，原发孔型房间隔缺损1例，膜周部室间隔缺损21例，二尖瓣前叶裂7例，二尖瓣前叶裂＋左房黏液瘤1例。采用外周体外循环技术；于右侧胸壁打3个直径为0．8cm、1个直径1．5cm的小孔后，机器人辅助下完成心内畸形矫正。术中食管超声引导建立体外循环及评估手术效果，术后常规随访。收集手术时间、体外循环时间、术后复查和随访资料并进行统计学分析。结果全组患者成功接受机器人辅助下心脏手术，无术式转化。其中76例房间隔缺损于心脏不停跳下完成。心脏停跳下房缺修补术的主动脉阻断时间随手术例数增加明显下降；心脏不停跳下房缺修补术手术时间随手术例数的增加逐步缩短。随访1～61个月，平均（29±16）个月，未见残余分流和恶性心律失常等并发症的发生。结论机器人技术可安全地应用于部分简单先心病矫正，是一种可供选择的微创术式。
Objective To summarize the clinical experiences on correction of congenital heart disease with robotic technology at a single center. Methods Between January 2007 and May 2012, this retrospective study recruited 160 consecutive patients undergoing robotic surgery for congenital heart diseases. There were 74 males and 86 females with a median age of 35 years （ range ： 11 - 62 ） . The procedures included secundum-type atrial septal defect repair （n = 130 ） , ostium primum defect repair （ n = 1 ）, perimembranous ventricular septal defect repair （ n = 21 ）, mitral valve repair for anterior leaflet cleft （ n = 7 ） and mitral valve repair plus left atrial myxoma resection （ n = 1 ）. Cardiopulmonary bypass graft was established through cannulation of right femoral artery, vein and right internal jugular vein under the guidance of transesophageal ultrasound. Myocardial protection was performed with cold blood cardioplegic solution or HTK solution and a transthoracic Chitwood clamp was used to occlude ascending aorta. Via three 8-mm ports and one 15-mm port in right chest, the microscopic instruments were manipulated to complete defect closure or mitral valve plasty, utilizing da Vinci S or da Vinci SI robotic system. Echocardiography was performed intraoperatively and at pre-discharge. Routine follow-ups were conducted. The clinical data of operating time, cardiopulmonary bypass time and follow-up examinations were retrospectively analyzed. Results All cases were treated successfully without a conversion into median sternotomy. No operative mortality or severe surgical complications were observed. Seventy-six cases of secundum-type atrial septal defect were completed on beating heart. The learning curves were noted for operating time of beating heart group and cross clamp time of arrest heart group. No residual shunt, malignant arrhythmia or mitral valve regurgitation was detected on intraoperative or postoperative echocardiography and during a median follow-up period of （29. 1 ± 16. 3 ） mo
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第32期2261-2264,共4页
National Medical Journal of China
基金
国家高技术研究发展计划（863计划）（2012AA021104）
关键词
机器人
微创手术
心脏缺损
先天性
Robotics
Surgical procedures, minimally invasive
Heart defects, congenital
