机器人微创非体外循环冠状动脉旁路移植术

目的 评价da Vincis机器人系统进行胸廓内动脉(IMA)游离、小切口非体外循环下冠状动脉旁路移植术的安全性和手术效果.方法 2007年1月到2011年3月,105例患者接受机器人IMA游离、小切口非体外循环下冠状动脉旁路移植术.其中男性77例,女性28例,年龄33～77岁,平均(59±10)岁.患者术前行64排CT检查评估IMA质量,2例患者左LIMA纤细或走行异常弃用.术者于操作台前、三维成像系统下遥控机器人游离IMA并完成动脉桥与靶血管的徒手吻合.其中4例患者旁路移植后接受了杂交技术于回旋支或右冠状动脉行支架植入术.术中均以超声血流检测仪测量桥血管的波形及血流.术后以冠状动脉造影或64排CT评估桥血管的通畅性,并进行随访.结果 所有患者成功接受上述手术,无手术死亡病例.术中平均IMA血管桥血流量为(21±13) ml/min.1例于术后第1天突发心跳骤停经抢救后痊愈,复查桥血管通畅.1例合并脑梗死患者术后肺部感染,痊愈后出院.其余患者无并发症发生.术中及术后出血少,术后恢复快.随访1～51个月,平均(30±12)个月.术后冠状动脉造影或64排CT复查未见桥血管狭窄或闭塞,心绞痛症状缓解.结论 机器人IMA游离、小切口非体外循环冠状动脉旁路移植术创伤小、疗效确切、安全性好,是微创冠状动脉再血管化的重要方向之一.

Robotically assisted coronary artery bypass grafting on beating heart

Objective To analyze the safety and efficiency of robotically assisted coronary artery bypass grafting (RACABG) on beating heart using da Vinci S system.Methods From January 2007 to March 2011,105 patients underwent RACABG on beating heart through minithoracotomy.There were 77 male and 28 female patients,aged from 33 to 77 years with a mean of (59 ± 10) years.After establishment of single left lung ventilation,the 3 trocars of da Vinci system were inserted into the left hemithorax,and robotic system was used to harvest the left internal mammary artery (LIMA) and/or right internal mammary artery (RIMA) from the subclavian vein to the internal mammary artery (IMA) bifurcation with skeletonized technique.After positioning the stabilizer,the LIMA was anastomosed manually to the left anterior descending or diagonal branch sequentially on beating heart through left minithoracotomy.The graft flow was evaluated by the Doppler flow meter after anastomosis was completed,and the graft patency was also evaluated by CT angiography or arteriography after surgery.Results All patients had successful RACABG on the beating heart,and the mean graft flow was (21 ± 13 ) ml/min.One patient suffered from cardiac arrest after the first postoperative day,but he recovered soon and CT angiography showed that graft was patent.One patient with preoperative stroke had postoperative pulmonary infection,and was discharged after treatment.After 4 to 5 days,4 patients received stent placement in right coronary artery or circumflex coronary in distinct hybrid session.There were no deaths or stroke or reintervention. All patients were discharged without complications and followed up.CTA or angiography revealed patent grafts in all patients,and the mean time of follow-up was (30 ± 12) months.Conclusions Robotically assisted coronary artery bypass grafting on beating heart can be performed safely using da Vinci S system.It is a new advanced approach of revascularization not only for patients with single vessel but with multi-vessel lesions as well.