机器人微创房间隔缺损修补术54例

Clinical application of robotic atrial septal defect closure using da Vinci S surgical system(54 cases report)

目的总结机器人、体外循环下心脏停跳下房间隔缺损修补术54例的手术方法和临床经验。方法 2007年1月至2010年12月,使用"达芬奇"(da Vinic S)机器人系统,完成房间隔缺损修补术54例。年龄12～60(35.2±13.1)岁,其中女性38例,男性16例。该组患者均为继发孔型房间隔缺损,缺损直径1.1～3.8(2.7±1.8)cm,无右向左分流,肺动脉压轻到中度升高。手术过程中无需正中开胸,股动静脉及右侧颈内静脉脉插管建立体外循环。右侧胸壁打0.8 cm的器械臂孔3个,直径为1.5 cm工作孔1个,术者于操作台前遥控微创器械进行房间隔缺损修补术。Chitwood钳经胸阻断升主动脉,升主动脉顺行灌注含血冷停搏液进行心肌保护。心脏停跳后右房入路,直接或心包片修补房缺,对重度三尖瓣关闭不全患者行三尖瓣成形。术中食道超声评估手术效果。结果所有患者均成功接受机器人房间隔缺损修补术,平均体外循环时间为(103.5±27.5)min,平均主动脉阻断时间(43.0±10.2)min。其中直接缝合房间隔缺损38例,心包补片修补房间隔缺损16例,同期三尖瓣成形4例。术后复查未见残余分流等并发症的发生。结论机器人微创房间隔缺损修补手术效果确实、可靠,是可供选择的微创术式之一。

Objective To summarize 54 cases of robotic atrial septal defect repair and to evaluate the efficiency and safety. Methods Fifty -four patients underwent robotic minimally invasive atrial septal defect repai from January 2007 to December 2010. The patients aged from 12 to 60 years, the average age was （35.2 ± 13.1 ） years old. Thirty -eight cases were female and 16 cases were male. All patients were ostium atrial septal defect. The defect diameter ranged from 1.1 -3.8 （2.7± 1.8） cm. All patients＇pul- monary artery pressure were gentle or medium value. Without sternotomy, the extracorporeal circulation （ECC） was established through cannulation of right femoral artery, vein and right internal jugular venous under the guidance of transesophageal echocardiography. The da Vinci S instrument arms were inserted through three 0.8 cm trocar incisions in the right side of the chest via 4 ports incision and 1.5 cm working port. The myocardial protection was performed with cold blood cardioplegic solution and the transthoracic Chitwood clamp was used to occlusion the ascending aorta. The surgeon can complete the procedure in the surgeon console with three dimensions visualization. The defects were repaired using direct or patch closure technique. The tricuspid valve repair was performed if necessary. The transesophageal echocardiography was used to evaluate the result of closure. Results The mean ECC time and aortic cross clamp time was （ 103.5 ±27.5） mins and （43.0 ± 10.2） mins respectively. The direct suturing was used in 38 cases, pericar- dial patch were used in 16 cases and 4 patients accepted tricuspid valve repair. There was no residual shunt was observed in follow - up. Conclusion Robotic atrial septal defect closure using da Vinie S surgical system is safe and effective.