全机器人心脏外科手术中经食管超声心动图的应用

Intraoperative transesophageal echocardiography in robot-assisted minimally invasive cardiac surgery

目的探讨术中经食管超声心动图（transesophageal echocardiography，TEE）在全机器人心脏外科手术中的作用。方法2007年1月至2011年3月，对接受全机器人心脏外科手术的193例患者行术中TEE检查，其中房间隔缺损111例，黏液样退行性变（瓣叶脱垂或连枷样瓣叶）所致二尖瓣反流51例，心房黏液瘤31例。TEE应用于：（1）体外循环（CPB）转机前，进一步明确病变性质及其发生部位；（2）建立外周CPB时，引导下、上腔静脉内插管及升主动脉内灌注针的置放；（3）心脏复跳后，即刻评价手术效果及有无手术相关并发症。结果以术中所见为标准，TEE诊断病变性质及其发生部位总的准确性分别为100％和98．8％。下、上腔静脉内插管及升主动脉内灌注针均置于适当位置，TEE引导置管成功率为100％。心脏复跳后，TEE显示所有患者手术均获成功，无手术相关并发症。结论术中TEE在全机器人心脏外科手术中不可缺少。

Objective To delineate the utility and results of intraoperative transesophageal echocardiography （TEE） in the evaluation of patients undergoing robot-assisted cardiac surgery. Methods Intraoperative TEE was performed in 193 patients undergoing robot-assisted procedures in cardiac surgery over a period of 4 years. （ 1 ） Before CPB, a comprehensive TEE was performed to document the lesions and their precise localization. （2） During establishment of peripheral CPB, a arterial cannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava; a venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava with its tip just inferior to the inferior vena cava-right atrium junction ; a arterial perfusion cannula was passed into the ascending aorta with its tip approximately 3 cm from the aortic valve under TEE guidance. （3） After weaning from CPB, TEE was performed to evaluate the efficiency of the procedure. Results （ 1 ） The concordance with surgical findings concerning the lesions and precise localization was 100% and 98.8% among all the patients, respectively. （2） All cannulae were located in the correct position. （3） TEE confirmed successful procedures with no concomitant complication in all the patients. Conclusion Intraoperative TEE is a valuable adjunct in the assessment of robot-assisted cardiac surgery.