机器人二尖瓣成形术术后7年随访结果分析  

Robotic mitral valve repair： perioperative and seven-year follow-up results

作　　者：刘国鹏[1] 杨明[1] 肖苍松[1] 王刚[1] 王加利[1] 王瑶[1] 高长青[1] 

机构地区：[1]解放军总医院心血管外科, 北京100853

出　　处：《中华医学杂志》2016年第29期2316-2320,共5页National Medical Journal of China

摘　　要：目的 总结机器人二尖瓣成形术的临床经验和长期随访结果,对机器人二尖瓣成形术的远期效果进行综合评估.方法 2007年1月至2014年9月共110例患者在解放军总医院心血管外科接受达芬奇机器人微创二尖瓣成形术治疗.患者年龄14 ～65（45±12）岁,男女比例2.3∶1,95.5％（105/110）被诊断为二尖瓣反流,4.5％（5/110）为二尖瓣狭窄,大部分患者（63.3％）采用三角或四边切除方式进行成形.术中共植入成形环93例,成形环植入的方法有：镍钛U形夹（58.1％,54/93）、连续缝合（31.2％,29/93）以及Cor-KnotTM缝合装置（10.8％,10/93）.收集临床数据,在术后定期进行心脏超声复查,随访最长持续时间为术后7年.结果 研究过程中,所有手术均由同一外科医师完成,1例中途改为正中开胸.患者术中体外循环时间为70 ～ 152（121.0±34.3） rmin,主动脉阻断时间为47 ～ 122（82.6 ±25.3）min.术后2例（1.82％）发生卒中,3例（2.73％）患者需进行二次手术.所有患者术后平均随访50个月（1个月～7年）,94.5％ （104/110）的患者未进行二次手术.结论 机器人二尖瓣成形术是一种相对安全有效的治疗方式,并有良好的远期效果.Objective To summarize surgical experience during the conduction of robotic mitral valve repair and evaluate the long-term follow-up results.Methods From January 2007 to September 2014,110 consecutive patients underwent robotic mitral valve repair under da Vinci Surgical System （Intuitive Surgical,USA） in Chinese PLA General Hospital were enrolled.The age of the patients was 14 to 65（45 ± 12） years old.The male to female ratio was 2.3∶ 1.Among them,95.5% （105/110） of the cases was diagnosed as mitral regurgitation and 4.5% （5/110） of them was diagnosed as mitral stenosis,and most of them （63.3%） needed triangular or quadrangular resection.Nitinol U-clips （58.1%）,running suture （31.2%） and Cor-KnotTM suture device （10.8%） were used to secure the annuloplasty ring.The operative data were collected and patients were regularly followed up echocardiographically as long as 7 years.Results All the surgeries were finished by the same surgeon.One case required conversion to sternotomy.The mean cardiopulmonary bypass （CPB） and cross-clamp time was 70 to 152 （121.0 ± 34.3） and 47 to 122 （82.6 ±25.3） minutes respectively.After surgery,one death （0.91%） and two cases of stroke （1.82%）occurred.Three cases of early prosthetic failure （2.73%） were noticed.All patients were successfully followed up for a median of 50 （range,1 month to 7 years） months and 94.5% （104/110） of them had no re-operation.Conclusion Robotic mitral valve repair is a safe and effective surgical method with excellent long-term outcomes.

关 键 词：外科手术 微创性 机器人 二尖瓣反流 

分 类 号：R654.2[医药卫生—外科学]