机器人辅助与全胸腔镜下不停跳房间隔缺损修补术的疗效观察

目的观察采用机器人手术系统(Da Vinci Si)辅助或全胸腔镜进行体外循环心脏不停跳下房间隔缺损(atrial septal defects,ASD)修补手术的近期临床效果。方法回顾性分析安徽医科大学第一附属医院2015年1月至2018年12月行机器人辅助下或全胸腔镜下ASD修补手术50例患者的临床资料。依据手术方式不同将患者分为机器人组和全胸腔镜组。机器人组35例,男11例、女24例,平均年龄(42.1±16.8)岁;全胸腔镜组15例,男8例、女7例,平均年龄(38.4±10.9)岁。随访期间,通过心脏多普勒超声心动图记录左心室射血分数、左心房直径、右心房直径、右心室舒张末期内径。记录并比较手术时间、体外循环时间、呼吸机使用时间、术后ICU滞留时间、术后住院时间、围手术期胸腔引流量、早期并发症。结果围手术期机器人组手术时间(3.8±0.3)h vs.(6.1±1.4)h]、体外循环时间(72.3±10.4)min vs.(139.1±32.8)min]、呼吸机使用时间(5.5±1.2)h vs.(9.5±2.1)h]、术后住院时间(6.7±0.5)d vs.(9.8±0.6)d]及胸腔引流量(253.4±26.8)mL vs.(289.3±29.5)mL]均短于或少于全胸腔镜组,差异均有统计学意义(P<0.05),而术后并发症发生率等方面差异无统计学意义(P>0.05)。全部患者术后1个月复查心脏彩超,扩张的右心房、右心室及左心房较术前缩小。结论对于ASD修补手术的患者,机器人辅助及全胸腔镜下均可取得良好效果,但在手术时间、体外循环时间、呼吸机使用时间、术后住院时间及胸腔引流量方面,机器人组更有优势。

Efficacy of robot-assisted surgery system versus total thoracoscopy for atrial septal defect repair on a beating heart

Objective To observe the short-term therapeutic outcomes of atrial septal defects(ASD)repair using on-pump beating-heart technique assisted by robotic surgery system(Da Vinci Si)or thoracoscopy.Methods Clinical data of 50 patients undergoing ASD repair at the First Affiliated Hospital of Anhui Medical University from January 2015 to December 2018 were retrospectively analyzed.According to the different surgical methods,patients were divided into a robot group and a total thoracoscopy group.In the robot group,there were 35 patients including 11 males and 24 females,at an average age of 42.1±16.8 years,and in the total thoracoscopy group there were 15 patients including 8 males and 7 females at an average age of 38.4±10.9 years.During follow-up,the left ventricular ejection fraction,left and right atrial diameter,and right ventricular end-diastolic diameter in the cardiac Doppler echocardiography were recorded.The operation time,extracorporeal circulation time,ventilation time,postoperative ICU stay,postoperative hospital stay,perioperative pleural drainage and early complications were compared between the two groups.Results In the perioperative period,the robot group had less operation time(3.8±0.3 h vs.6.1±1.4 h),extracorporeal circulation time(72.3±10.4 min vs.139.1±32.8 min),ventilation time(5.5±1.2 h vs.9.5±2.1 h),postoperative hospital stay(6.7±0.5 d vs.9.8±0.6 d)and thoracic drainage(253.4±26.8 mL vs.289.3±29.5 mL)than the total thoracoscopy group(P<0.05),while the postoperative complications were not statistically significant between the two groups(P>0.05).All patients were reviewed by color Doppler ultrasound at 1 month after operation. The postoperative dilated right atrium, right ventricleand left atrium were smaller than those before surgery. Conclusion For patients undergoing ASD repair, robot-assistedand total thoracoscopy can achieve good results, but the robot group has more advantages in terms of operation time,extracorporeal circulation time, ventilation time, postoperative hospital stay and thoracic drainage.