机器人微创技术在成人室间隔缺损修补术中的应用

Totally endoscopic robotic adult ventricular septal defect repair--a retrospective clinical observation

目的总结机器人微创技术在成人室间隔缺损修补术中的应用经验，评估该技术的安全性与疗效。方法2009年1月至2015年10月，完成30例机器人微创室间隔缺损（VSD）修补术，男20例，女10例；年龄16～45岁，平均（29．0±9．5）岁。术前超声心动图显示VSD大小2～15mm，平均（6．1±2．8）mm；4例并发卵圆孔未闭。所有手术均使用达芬奇机器人手术系统，于患者右侧胸部打3个直径为0．8cm的小孔和1个2．5Cm的工作孔。外周动静脉插管建立体外循环。19例采用直接连续缝合法闭合VSD，11例加用补片闭合VSD。结果所有患者手术成功。体外循环（89．7±23．7）min，主动脉阻断（40．1±14．9）min。总手术时间180～300min，平均（225．0±34．8）min。术后超声心动图显示室间隔完整，无左向右分流及房室传导阻滞。术后平均住院5天。术后1周患者恢复正常生活，无并发症。平均随访23个月（1—89个月），未发现残余分流。结论机器人微创技术行成人室间隔缺损修补术疗效确切，安全可行。

Objective As previously reported, da Vinci Surgical System has been used to treat total endoscopic ventricu- lar septal defect repair in the adult. Its promising results motivated us to extend the application scope of this technology, and use it to treat some more complicated patients with ventricular septal defect. Methods 30 patients underwent total endoscopic robotic ventricalar septal defect repair from January 2009 to October 2015. The average patient age was（ 29.0 ± 9.5 ） years old （range from 16 to 45 ）. Among them, 10 were female and the others were male. The echocardiogram showed that the average diameter of the ventricular septal defect was（6.1 ± 2.8 ） mm（ range from 2 to 15 ）, and 4 patients had concomitant patent fora- men ovalc. During the ventricular septal defect closure, 19 patients were directly secured with interrupted mattress sutures, and 11 patients were patched. All the procedures were finished by using the da Vinci robot and 3 port incisions and a 2.0 - 2.5 cm working port in the right side of the chest is necessary. Results All patients were operated successfully. The mean cardiopul- monary bypass was（89.7 ± 23.7 ） min （range from 64 to 140 min） , and the mean crossclamp time was （40. 1 ± 14.9 ） min （ range from 22 to 75 ）. The mean operation time was （ 225.0 ±34.8 ） minutes （ range from 180 to 300 min）. The postoperative transesophageal echocardiogram demonstrated an intact ventricular septum. No residual left-to-right shunting and no permanent- ly complete atrioventricular dissociation was found. The mean hospital stay was 5 days. No residual shunt was found during a mean follow-up of 23 months（ range from 1 to 89）. The patients returned to normal function within 1 week without any compli- cations. Conclusion Total endoscopic robotic ventricular septal defect repair in adult patients is feasible, safe, and efficacious.