机器人辅助获取双侧乳内动脉行微创冠状动脉旁路移植术治疗冠心病多支血管病变  

Clinical effect of robot-assisted bilateral internal mammary arteries(IMAs)harvesting in treating coronary heart disease with multi-vessel lesions by minimally invasive coronary artery bypass grafting

作　　者：成楠[1] 杨明[1] 王明岩[1] 刘冰[1] 申华 郭鹏飞[1] 赵元程 贺田田 许克 王嵘[1] CHENG Nan;YANG Ming;WANG Mingyan;LIU Bing;SHEN Hua;GUO Pengfei;ZHAO Yuancheng;HE Tiantian;XU Ke;WANG Rong(Department of Cardiovascular Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心血管外科,北京100853

出　　处：《机器人外科学杂志（中英文）》2020年第1期43-49,I0018,共8页Chinese Journal of Robotic Surgery

基　　金：2017全军保健专项课题《机器人微创“杂交”技术治疗冠心病多支血管病变在医疗与保健工作中的应用研究》(17BJ31)。

摘　　要：目的:评价机器人辅助获取双侧乳内动脉在微创冠状动脉旁路移植手术治疗冠心病多支血管病变的应用效果。方法:选取2019年1月~2020年1月接受机器人辅助左前外侧小切口微创冠状动脉旁路移植术的45例冠心病多支血管病变患者,其中29例为机器人辅助获取双侧乳内动脉,平均年龄(59.2±9.5)岁,男性占比72.4%,术前冠脉造影双支病变20例(68.9%),三支病变9例(31.1%),14例患者同时获取大隐静脉作为桥血管材料。结果:全组患者无死亡,无围术期卒中、心肌梗死、二次开胸止血等严重并发症,无患者中转正中开胸。1例患者切口愈合不良经换药后痊愈。29例患者成功获取乳内动脉58条,术中检测血流均满意。桥血管配置方面,右乳内动脉至左前降支/左乳内动脉至其它靶血管10例,左乳内动脉至前降支/右乳内动脉-大隐静脉复合桥至其它靶血管19例。平均吻合口数量(2.27±0.3)个/例,平均桥血管流量(27.3±17.6)ml/min。结论:机器人辅助获取双侧乳内动脉在国人冠心病患者安全可行,近期结果满意,适于在冠心病多支血管病变的微创外科治疗领域推广应用。Objective:To evaluate the clinical effect of robot-assisted bilateral internal mammary arteries(IMAs)harvesting in the treatment of coronary heart disease with multi-vessel lesions by minimally invasive coronary artery bypass grafting.Methods:45 patients with multivessel coronary artery disease underwent robot-assisted minimally invasive coronary artery bypass surgery via left anterolateral small incision from January 2019 to January 2020 in our hospital,of which 29 patients received totally robotic bilateral IMAs harvesting with mean age(59.2±9.5)years and 72.4%males.20 cases(68.9%)diagnosed with double lesions and 9 cases(31.1%)with triple lesions in preoperative coronary angiography.14 patients were performed saphenous vein harvesting for bypass grafting during the operations.Results:There were no death,perioperative stroke,myocardial infarction,reexoploration for hemostasis and other serious complications,and no patient was converted to median sternotomy.One patient with poor wound healing recovered after conservative treatment.Fifty-eight IMAs were successfully harvested in 29 patients,and the intraoperative blood flow was satisfactory.In terms of graft configurations,10 cases had the RIMA to the left anterior descending(LAD)/LIMA to other target vessels,and 19 cases had the LIMA to LAD/RIMA-SVG composite graft to other target vessels.The average number of anastomoses was(2.27±0.3)/case,and the average graft flow was(27.3±17.6)ml/min.Conclusion:It is safe and feasible to harvest IMAs with robot for Chinese coronary heart disease patients,which is helpful to the application of minimally invasive robotic CABG in the treatment of coronary multi-vessel disease.

关 键 词：机器人 双侧乳内动脉 冠心病 多支血管病变 冠状动脉旁路移植术 

分 类 号：R654[医药卫生—外科学]