机器人外科手术系统体外循环心脏手术的初步经验  

Total endoscopic robot-assisted on-pump cardiac surgery:preliminary experience with robot-assisted surgery

作　　者：魏来[1] 王春生[1] 沈金强[1] 夏利民[1] 罗红[2] 廖庆武[2] 胡克俭[1] 王萍[1] 徐竹静[1] 黄麒[1] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《上海医学》2011年第1期38-42,F0004,共6页Shanghai Medical Journal

基　　金：上海市重点学科建设项目资助(B116)

摘　　要：目的介绍复旦大学附属中山医院应用达芬奇S机器人外科手术系统辅助开展全内镜体外循环心脏手术的初步经验。方法 2010年8-12月在达芬奇S机器人外科手术系统辅助下完成全内镜二尖瓣成形术5例,房间隔缺损修补术5例。全组患者均采用双腔气管插管、静脉吸入复合麻醉,经股动脉、股静脉及右颈内静脉插管建立外周体外循环。于右胸第4肋间隙作3cm工作孔,右胸第3、4、6肋间隙分别作0.8cm器械孔,由术者操控机械臂完成全内镜下心内直视手术。结果所有患者手术均取得成功,二尖瓣成形与房间隔缺损修补的效果满意,食管超声显示二尖瓣无或轻微反流,房间隔无残余分流。均无中转开胸、院内死亡及术后并发症发生。术后出血少,恢复快,住院时间短。随访1～3个月,超声心动图检查结果满意。结论达芬奇S机器人外科手术系统辅助全内镜体外循环心脏手术安全可靠,疗效满意,且创伤小、恢复快,具有良好的发展前景。Objective To introduce our preliminary experience in total endoscopic robot-assisted onpump cardiac surgery with da Vinci system.Methods Five patients with mitral insufficiency（Ml） and five patients with atrial septal defect（ASD） underwent on-pump cardiac surgical procedures using da Vinci S system from Aug.2010 to Dec.2010.After double-lumen endotracheal intubation and intravenous inhalation anesthesia, the peripheral extracorporeal circulation was established with femoral arterial cannula,femoral venous cannula and right internal jugular venous cannula.Through a 3 cm-length working-port and other three 0.8 cm-length mini-ports, the total endoscopic robotic-assisted operations（including mitral valve repair and ASD repair） were performed. Results All procedures were successfully performed without incision expansion or converting to sternotomy. Transesophageal echocardiography（TEE） showed no moderate or severe mitral valve regurgitation or atrial septal shunt.There were no in-hospital death or post-operative complications.The patients recovered quickly with less bleeding and shorter hospital stay.All patients were followed-up for 1—3 months and had satisfactory TEE results. Conclusion The da Vinci robotic surgery system is safe and reliable for cardiac surgery,with satisfactory outcome,mini-invasiveness.rapid recovery and bright future.

关 键 词：机器人外科手术系统 微创 体外循环 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]