机器人辅助下冠状动脉旁路移植术1例

Minimally invasive direct coronary artery bypass grafting utilizing robotic assisted instruments

目的 :报告 1例机器人辅助下微创直视冠状动脉旁路移植成功 ,讨论其临床方法及意义。方法 :于左胸壁造 3个小窗孔 ,分别置入胸腔镜、电灼和特制组织钳 ,在自动胸腔镜引导下行IMA游离、切取。医生一边注视显视屏上经过放大的三维图像 ,一边用手进行操纵。无须胸骨劈开游离IMA。在行冠状动脉旁路手术时 ,仅在胸骨旁作一小开胸切口 ,不用心肺机辅助 ,完成IMA与靶血管吻合。结果 :术后病人反应轻微 ,于当日晚拔除气管插管 ,术后 12h服用阿斯匹林。第二天下床活动。随访 6个月 ,近期结果良好。结论 :初步结果显示 ,此种微创心脏手术对治疗单独左前降支阻塞患者结果良好 ,其将成为除PTCA外 。

Objective:A successful case of minimally invasive direct coronary artery bypass grafting (MIDCABG) utilizing robotic assisted instruments was reported.The patient was a male,59 years old.The coronary arteriography showed left anterior descending branch became severely narrow (90% space loss) and old anterior myocardial infarction.The aim here were to search the clinical methods and their signification of MIDCABG with robotic assisted instruments.Method:The technique used in operations consisted of single lung ventilation and carbon dioxide insufflation.Three small stab wounds were used for the harvest of the internal mammary artery (IMA).Control of the thoracoscope was accomplished using a voice\|activated robotic arm.After completion of the IMA harvesting phase,the pericardium was opened and the target vessel was identified.A 5 cm incision was made through the fourth intercostal space.The anastomosis was sewn without cardiopulmonary bypass.Result:The total operation time took 186 minutes.IMA harvesting took 52 minutes.Coronary artery cross\|clamp time was 20 minutes.Anastomoses were 12 minutes.Postoperatively,patient remained in the intensive care unit for 24 hours.Hospital stay times were 9 day postoperatively.Follow\|up was obtained 6 months and the results was satisfactory.Conclusion:Patient with isolate anterior descending revascularization can be benefited by robotic assisted thoracoscopic for the harvest of the IMA with distinctly reduced surgical trauma,and quick recovery.The new techniques is safe,effective,and with an acceptable clinical outcome.