达芬奇机器人手术系统在51例心脏手术中的应用

 目的 总结复旦大学附属中山医院应用达芬奇机器人手术系统行心脏手术的临床经验。方法 2009年8月至2012年10月,共51例患者接受达芬奇机器人手术系统辅助心脏手术,其中男性39例,女性12例,年龄15~80岁,平均58.8岁,其中微创冠状动脉旁路移植术(minimally invasive coronary artery bypass grafting,MIDCAB)24例,二尖瓣成形术20例,房缺修补术5例,左房黏液瘤切除术2例。结果 50例患者成功接收达芬奇机器人辅助心脏手术,无院内死亡;1例患者因获取左乳内动脉(left intemal mammary artery,LIMA)时近端出血难以控制,中转胸骨正中切口。23例患者成功完成乳内动脉获取,平均获取时间为78.3 min;27例体外循环手术平均体外循环时间和主动脉阻断时间分别为139.1 min和84.5 min。所有患者术后平均机械通气时间和ICU时间分别为4.2 h和15.1 h,术后平均住院时间为4.2天,患者住院期间平均引流量为188.4 mL,46例患者(90.2%)住院期间未接受任何血制品输注。术后随访3~25个月,1例冠脉搭桥术后患者因心衰死亡,余患者恢复良好。结论 达芬奇机器人手术系统行心脏手术安全有效,既缩短ICU时间和术后住院时间,又减少住院期间血制品的使用,可选择性应用于单支病变的冠脉搭桥手术、二尖瓣成形手术、房缺修补手术、黏液瘤切除手术等。

Application of da Vinci system for cardiac surgery in 51 patients

Objective To evaluate the safty and efficacy of robotic cardiac surgery using da Vinci surgical system. Methods From Aug. 2009 to Oct. 2012, 51 cases of robotic cardiac surgery have been completed in Zhongshan hospital of Fudan University using da Vinci surgical system. There were 39 male and 12 female patients, aging from 15 to 80 years with a mean age of 58.8 years, including 24 cases of minimally invasive coronary artery bypass grafting (MIDCAB), 20 cases of mitral valvuloplasty, 5 cases of atrial septal defect repair and 2 cases of left atrial myxoma resection. Results The operations were successfully performed on 50 patients except one conversion to sternotomy because of uncontrollable proximal bleeding of left internal mammary artery (LIMA). There were  no operative mortality. The median for LIMA harvesting time was 78.3 min in 23 cases. Mean cardiopulmonary bypass time and aortic clamping time were 139.1 minutes and 84.5 minutes in 27 cases. Mean duration of mechanical ventilation, length of ICU stay and postoperative hospital stay were 4.2 h, 15.1 h and 4.2 d. The mean  drainage was 188.4 mL. 90% of the patients did not receive any transfusion. The mean time of follow-up was 3 to 25 months; a good recovery was obtained in all patients except one who died of heart failure 9 months after coronary artery bypass grafting. Conclusions Robotic cardiac surgery without sternotomy is safe and effective using the da Vinci surgical system with shortened length of ICU and postoperative hospital stay and reduction tranfusion during hospitalization, and is worth applying to selective clinical  application for treatment of single or dual-vessel coronary artery disease, mitral valve regurgitation,atrial septal defect and atrial myxoma.