摘要
目的总结机器人胸廓内动脉（ITA）游离的临床经验，探讨该技术学习曲线和应用于冠状动脉旁路移植术后桥血管的中期通畅率。方法回顾性分析2007年4月至2012年8月解放军总医院心血管外科200例机器人ITA游离患者的临床资料，其中男154例，女46例；年龄33-79（58．7±10．1）岁。术前64层螺旋CT（64-MSCT）检查双侧ITA，术中使用机器人手术系统、骨骼化法游离单侧或双侧ITA。获取ITA后，根据靶血管情况行非体外循环、全机器人或侧胸壁小切口下冠状动脉旁路移植术。对数曲线回归分析建立机器人ITA游离学习曲线。术后1-5年复查64-MSCT，明确动脉桥血管通畅率。结果1例患者因重度胸膜粘连改为正中开胸，其余患者顺利接受机器人ITA游离：190例左侧ITA（LITA）游离，5例右侧ITA（RITA）游离，4例双侧ITAs游离，无ITA严重损伤而弃用病例。单侧ITA游离时间为16-70（35．8±8．7）min，ITA游离时间的学习曲线为：y（min）=58．0-5．31n（x）（r^2=0．33，P〈0．01）。术后第1年和2年时ITA桥血管通畅率分别为98．1％和97．8％，术后3至5年的通畅率未见下降。结论克服学习曲线后，机器人系统可安全高效地游离ITA，动脉桥血管的中期通畅率良好。
Objective To summarize our experience of robotic internal thoracic artery （ITA） skeletonized harvesting in Asian patients and evaluate the learning curves of robotic ITA harvesting and ITA graft patency. Methods A total of 200 patients underwent totally robotic ITA takedown at our department from April 2007 to August 2012. ITA was harvested in a skeletonized fashion and learning curve estimated. Coronary artery bypass grafting was completed in minimally invasive direct coronary artery bypass graft （MIDCAB） or totally endoscopic coronary bypass graft on beating heart （BH-TECAB） manners after robotic ITA harvesting. The coronary angiography or 64-MSCT was performed to evaluate the patency of ITA graft before discharge and at Year 1 -5 postoperatively. Results One patient underwent median sternotomy for severe plural adhesion. Left ITA （ LITA, n = 190）, right ITA （ RITA, n = 5） and double-ITA （ n = 4） were harvested. The mean duration of single ITA harvesting was 18 - 70 （ 35.8 ± 10. 7 ） min. A significant learning curve was observed ： y （min） = 58.0 - 5.3 x in （x） （ r2 = 0. 33, P 〈 0. 01 ）. ITA patency was 98.1% at Year 1 and 97.8% at Year 2 postoperatively respectively. And there was no recurrence of ITA occlusion at Years 3 -5. Conclusions Robotic ITA takedown is a prerequisite for totally endoscopic coronary bypass graft and can be performed safely and within an acceptable time after overcoming a learning curve. ITA graft patency has comparable outcomes of conventional surgery.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第6期428-431,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）
全军医学科技“十二五”重点项目（BWS11-J030）
