摘要
目的:确定利用机器人设备经右胸行内镜下二尖瓣手术的安全性和有效性。方法:对2002年12月至2005年11月间接受内镜下机器人辅助二尖瓣手术的127例患者进行回顾性调查。患者年龄为54±13岁,其中58%为男性。121例患者的二尖瓣反流为4+,4例为3+,2例为2+。19例(15%)患者的左心室射血分数≤50%。
Objective: To determine the safety and efficacy of endoscopic mitral valve surgery using robotic instruments through the lateral right chest. Methods: We conducted a retrospective review of 127 patients taken to the operating room for endoscopic robotic mitral surgery from December 2002 through November 2005. Mean age was 54±13 years and 58%were male. Mitral regurgitation was 4+in 121 patients, 3+in 4 patients, and 2+in 2 patients. Nineteen(15%) patients had a left ventricular ejection fraction of 0.50 or less. Surgical approach was through 4 right chest ports with femoral perfusion and endoaortic balloon occlusion. Mean follow-up was 13.7±8.9 months and was 100%complete. Echocardiographic follow-up was available on 98 patients with a mean of 8.4±8.1 months. Results: The mitral procedure was completed endoscopically in 121(95%)patients. Mitral valve repair was performed in 114 patients and mitral valve replacement in 7 patients. Two patients required reoperation on the mitral valve. There was 1(0.8%) hospital death and 1 late death. Echocardiographic follow-up in 98 survivors of endoscopic mitral repair revealed 0-1+regurgitation in 95(96.9%) and 2+in 3(3.1%) patients. Conclusions: Totally endoscopic mitral surgery can be performed safely with robotic instrumentation. A right lateral configuration of the robotic system allows excellent visualization of the valve with minimal distortion and permits two surgical personnel to participate actively in valve instrumentation. In selected patients with mitral valve disease, this surgical approach might promote higher rates of valve repair.
