经食管超声心动图在机器人心脏手术中的应用

目的探讨经食管超声心动图(transesophageal echocardiography，TEE)在机器人体外循环心脏手术中的应用价值。 方法对110例心脏病患者在机器人体外循环术中行TEE检查，体外循环转机前评估心脏病变，验证经胸超声心动图(transthoracic echocardiography，TTE)结果，根据结果协助手术医师进一步确定手术方案。建议外周体外循环过程中，TEE引导下腔静脉插管(经股静脉)、上腔静脉插管(经右侧颈内静脉)。心脏复搏后，TEE评估手术疗效、手术并发症、排气情况。将其结果进行回顾性分析。 结果本组患者全在机器人下完成手术，其中2例中转右前外侧切口。体外循环转机前TEE诊断与TTE结果有7例不相符，经术中证实TEE准确性100%。TEE引导所有下、上腔静脉插管成功，成功率100%，体外循环过程中无静脉引流不畅。心脏复搏后2例室间隔缺损有残余分流、1例二尖瓣成形后仍有中度反流、1例主动脉瓣置换术后瓣周漏，经再次阻断处理后均取得满意效果。其余患者手术疗效确切，术后再次TTE证实无手术相关并发症。 结论TEE在机器人体外循环术中能提高手术成功率及安全性，是有效的术中诊断手段。

Application of transesophageal echocardiography in robot cardiac surgery

ObjectiveTo explore the application value of transesophageal echocardiography(TEE) in robotic cardiac surgical procedures requiring peripheral cardiopulmonary bypass (CPB). MethodsTEE was performed in 110 heart disease patients underwent robotic cardiac surgical procedures requiring peripheral CPB. Before CPB, The results of transthoracic echocardiography (TTE) were validated and assisted the surgeon to further determine the operation plan. During the establish peripheral CPB, TEE was used to guide cannulation of the inferior vena cava (IVC), superior vena cava (SVC) by way of the femoral vein and right internal jugular vein. After cardiac resuscitation, TEE assessed the surgical efficacy, complications and exhaust status. The results were analyzed retrospectively. ResultsAll the operations were performed under robots, and 2 cases were transferred to right anterolateral incision. There were 7 discrepancies between TEE and TTE, and the accuracy of TEE was 100% proven by surgery. TEE guided cannulation of the IVC or SVC was successful in all patients (100%) and no venous cannulae was obstructed during CPB. 2 cases of ventricular septal defect had residual shunt after cardiac resuscitation, 1 case had moderate regurgitation after mitral valvuloplasty, and 1 case had perivalvular leakage after aortic valve replacement. Satisfactory results were achieved after aortic cross-clamping again. The other patients had definite surgical effect, and TTE confirmed that there were no operative complications. ConclusionsTEE can improve the success rate and safety of robotic cardiac surgery requiring peripheral CPB, and is an effective means of intraoperative diagnosis.