机器人外科手术系统辅助下乳内动脉获取的经验和技巧  

Robot-assisted surgery in harvesting internal mammary artery:experience and skills

作　　者：蔡俊锋[1] 孙延军[1] 王哲[1] 陈安清[1] 董榕[2] 赵强[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心脏外科,200025 [2]上海交通大学医学院附属瑞金医院麻醉科,200025

出　　处：《上海医学》2011年第1期43-46,I0001,共5页Shanghai Medical Journal

摘　　要：目的总结达芬奇S机器人外科手术系统辅助下获取乳内动脉制备桥血管的经验和技巧。方法 2010年5-9月,22例患者接受达芬奇S机器人外科手术系统辅助下冠状动脉旁路移植术,男16例,女6例,平均年龄为(61.3±11.9)岁。所有患者均有心绞痛病史,经冠状动脉造影检查示左前降支严重狭窄,欧洲心脏手术危险因素评价系统(EuroSCORE)评分中位数为2分。所有患者在达芬奇S机器人外科手术系统辅助下游离骨骼化乳内动脉,制备桥血管,然后取做创小切口行乳内动脉至左前降支冠状动脉旁路移植术。结果 22例患者中共20例在达芬奇S机器人外科手术系统辅助下成功获取乳内动脉,平均获取时间为(40.8±18.6)min。1例患者的乳内动脉游离后发生痉挛,改用大隐静脉;1例患者的乳内动脉出现远端血肿,另取大隐静脉端端吻合作为桥血管。所有乳内动脉至左前降支的吻合口满意,乳内动脉流量为(19.5±8.6)mL/min,搏动指数为2.7±1.1。无手术死亡者,无围术期心肌梗死,无术后感染等并发症发生,仅1例患者术后出现胸腔积液。2例患者因术后出血再次行手术治疗。结论术前对患者进行三维CT成像,选择合适的切口位置,选用较低的电凝功率,解剖操作轻柔,保持胸腔引流通畅,均有助于机器人外科手术系统辅助乳内动脉的获取。Objective To summarize our initial experience in using the da Vinci Surgical System for internal mammary artery harvesting.Methods Between May 2010 and Sept.2010,22 patients received da Vinci assisted minimally invasive coronary artery bypass grafting;the patients included 16 males and 6 females,with the mean age being（61.3±11.9） years old.All patients had been confirmed to have serious stenosis on the left anterior descending artery（LAD） by coronary angiography,with the mean EuroSCORE being 2.The da Vinci Surgical System was used to harvest the left internal mammary artery（LIMA） in a skeletonized fashion in all patients,and then through a small anterolateral thoracotomy and LIMA-LAD anastomoses were performed by using Genzyme stabilization.Results LIMAs were successfully harvested in 20 of the 22 patients,with the mean harvesting time being（40.8±18.6） min.The LIMA was spasm after harvested in one patient.Hematoma was found in the LIMA of another patient.All anastomoses were satisfactory.The mean flow rate in LIMA was（19.5±8.6） mL/min and the mean plus index was 2.7±1.1.There was no mortality,stroke,myocardial infarction,or wound infection after operation.Hydrothorax was found in one patient.Reoperation for postoperative bleeding was performed in two patients.Conclusion Pre-operation CT scan,proper port location,low energy cautery,gentle dissection and effective drainage are helpful for the robotic internal mammary artery harvesting.

关 键 词：机器人外科手术系统 乳内动脉 微创手术 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]