术中经食管超声心动图在全机器人房间隔缺损修补术中的作用

The importance of intraoperative transesophageal echocardiography in totally endoscopic atrial septal defect repair with robotic assistance

目的探讨术中经食管超声心动图（TEE）在全机器人房间隔缺损（ASD）修补术中的作用。方法对24例拟行全机器人ASD修补术的患者进行前瞻性研究。全身麻醉诱导及双腔气管插管后，将TEE探头插入食管中段。①体外循环转机前，进一步明确ASD类型、数目及大小；术者参考上述信息初步拟定手术方案。②建立体外循环时，在TEE引导下，经右股静脉插入-19F或21F股静脉插管至下腔静脉一右心房连接处；经皮经右颈内静脉插入-15F或17F股动脉插管至上腔静脉；于第二肋间经皮将-14G心脏停搏液灌注针插入升主动脉管腔中央偏后、距主动脉瓣口约3cm处。③心脏复跳后，应用TEE即刻评价房间隔水平有无残余分流及有无手术相关并发症。结果①以手术结果为标准，TEE诊断ASD类型、数目的准确性为100％；所有患者修补ASD均按术前拟定方案进行。②术中证实，所有患者下、上腔静脉内插管及升主动脉内灌注针均放置于适当位置，TEE引导置管成功率为100％。③心脏复跳后，TEE显示所有患者房间隔水平均无残余分流，均无手术相关并发症。结论术中TEE在全机器人ASD修补术中必不可少。

Objective To explore the importance of intraoperative transesophageal echocardiography（TEE） in totally endoscopic atrial septal defect（ASD） repair. Methods Twenty four patients underwent repair of ASD by a totally endoscopic approach,utilizing the da Vinci S robotic system. After induction of general anesthesia and a left-sided double-lumen endotracheal tube was positioned, a TEE probe was inserted. ①Before cardiopulmonary bypass（CPB） ,TEE examination was conducted to document the types and size of ASD. The procedures were predetermined by the operator according to the TEE diagnosis. ②CPB was achieved peripherally. With TEE guidance,a 19-or 21-Fr. femoral venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava（IVC） ,with its tip just inferior to the IVC-right atrium junction;a 15- or 17-Fr. femoral arterial cannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava（SVC）. The bypass circuit was completed by inserting a 14G arterial perfusion cannula into the ascending aorta（AAO） ,with its distal tip passing over the center of the AAO,approximately 3 cm from the aortic valve. ③ After weaning from CPB,TEE examination was performed again. Results ①Surgical confirmation was obtained in all the patients and no operative procedures were changed.②All venous, arterial and arterial perfusion cannula were located in correct position.③In all patients, TEE after weaned from CPB confirmed successful repair. Conclusions Intraoperative TEE is essential for totally endoscopic ASD repair.