机器人辅助下房间隔缺损修补术学习曲线与临床结果的相关性

目的 明确单中心的机器人辅助下房间隔缺损修补术的学习曲线及临床结果.方法 回顾性分析2007年1月至2010年12月完成的94例机器人房间隔缺损修补术,按术式不同分成心脏停搏组(54例,Ⅰ组)和心脏搏动组(40例,Ⅱ组).记录每组手术、体外循环、主动脉阻断、术后呼吸机辅助、住ICU和住院时间等指标,采用对数曲线回归分析建立学习曲线,并分析上述指标与临床结果的相关性.结果 两组均无手术死亡或严重并发症发生,术中及术后超声复查未见残余分流.Ⅰ组方法学习曲线为:y(min)=68.741 -8.283(n)(x) (r2 =0.489,P＜0.01)；Ⅱ组方法学习曲线为:y(min)=355.51 -56.29(n)(x)(r2 =0.581,P＜0.01).手术、体外循环和主动脉阻断时间与术后呼吸机辅助、住ICU和住院时间无相关性.结论 机器人辅助下房间隔缺损修补术安全、可靠,学习曲线显著,手术时间延长不影响患者恢复.

Totally robotical atrial septal defect repair: learning curves and correlate analysis

Objective The aim of this study is to address learning curve and clinical outcomes of totally robotic atrial septal defect repair on the basis of a single - center experience.Methods 54 cases of atrial septal defect (ASD) were repaired using “da Vinic S" surgical system on arrested ( group Ⅰ,54 cases) or beating heart ( group Ⅱ,40 cases) from January 2007 to December 2010.Learning curves were assessed by means of regression analysis with logarithmic curve fit.The effect of operative variables on clinical outcome was analyzed by linear by regression using the Spearman's rho coefficient.Results All cases were accomplished successfully without complications.No residual shunt was detected at intraoperative or postoperative echocardiography.Significant learning curves were noted for corss clamp time in group Ⅰ:y (min) =68.741 -8.283 (n) (x)( r2 =0.489 ; P ＜ 0.01 ) ; the operation time in group Ⅱ:y (min) =355.51 - 56.29 (n) (x) ( r2 =0.581 ; P ＜ 0.01 ).No correlation was detected between operation time,cardiopulmonary bypass time,or cross clamp time and intubation time,intensive care unit stay,or total length of stay.Conclusion The robotic atrial septal defect repair can be performed safely.The learning curves is steep and the longer cardiopulmonary bypass times,operation time or cross clamp time had no negative impact on intraoperative and postoperative outcome.