达芬奇系统下改良不停跳房间隔缺损修补及学习曲线的临床研究  

The improved Da Vinci robot-assisted atrial septal defect repair under beating-heart cardiopulmonary bypass and its learning curve

作　　者：唐义虎 吴延虎 周景昕 朱锦富 刘翔 李明科 戴亚伟 TANG Yi-hu;WU Yan-hu;ZHOU Jing-xin;ZHU Jin-fu;LIU Xiang;LI Ming-ke;DAI Ya-wei(Department of Cardiovascular Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院心脏大血管外科,江苏南京210029

出　　处：《中国临床研究》2020年第10期1314-1319,共6页Chinese Journal of Clinical Research

基　　金：南京市科技局项目(20175002)。

摘　　要：目的采用回顾性研究方法通过对传统机器人心脏手术方式(使用一个腔镜机械臂、三个操作机械臂及多个专用手术器械)进行改良,仅使用两个机械臂和两把机器人专用手术器械,探讨其应用于不停跳房间隔缺损(ASD)修补术的安全性及有效性。方法南京医科大学第一附属医院心脏大血管外科在2016年12月至2018年9月共完成达芬奇系统下改良不停跳ASD修补术47例,经回归分析制作体外循环(CPB)时间及手术时间的学习曲线;并选取在学习曲线上达到稳定状态后2017年9月至2018年9月接受达芬奇系统下改良不停跳ASD修补术的25例患者作为改良机器人组;选择同期27例接受经胸壁3D胸腔镜下“三孔法”不停跳ASD修补术的患者作为3D胸腔镜组。两组患者均经股动静脉及颈内静脉插管建立外周血管CPB。对两组患者的围手术期情况、手术相关数据及术后随访等情况进行对比。结果所有患者均成功接受了手术治疗,无死亡或其他严重并发症。经回归分析并制作学习曲线,47例改良机器人达芬奇系统下不停跳ASD修补术的手术时间学习曲线为y=302-41.79ln(x)(r^2=0.904,P<0.01);CPB时间学习曲线为y=162-40.684ln(x)(r^2=0.877,P<0.01)。改良机器人组同期行三尖瓣成型12例(48.00%),3D胸腔镜组同期行三尖瓣成型11例(40.74%),两组接受三尖瓣成型术的比例相当(P>0.05)。改良机器人组CPB时间、术后呼吸机使用时间短于3D胸腔镜组,手术时间长于3D胸腔镜组(P<0.05,P<0.01)。两组患者术后ICU停留时间、术后引流量、术后住院天数等差异无统计学意义(P均>0.05)。两组患者术后3、30、90、180d随访,二维超声心动图检查均未发现残余分流或三尖瓣反流等。结论改良机器人不停跳ASD修补术是一种安全有效的手术方式,经学习曲线达稳态后其手术时间及CPB时间均趋于稳定;该术式可更快的完成镜下操作,缩短CPB时间,减少患者的手术创�Objective To investigate the safety and feasibility of the improved robot-assisted atrial septal defect(ASD) repair under beating-heart(using two robotic arms and two special instruments for robotic surgery),through a retrospective study.Methods From December 2016 to September 2018,47 cases of modified robot-assisted ASD repair under beating-heart were completed in the Department of Cardiovascular Surgery of First Affiliated Hospital of Nanjing Medical University.Based on the steady-state learning curve of cardiopulmonary bypass(CPB) time and operation time made by regression analysis,25 patients from September 2017 to September 2018 were selected as modified robot group;27 patients undergoing ASD repair by 3 D thoracoscopy with three-ports were served as 3 D thoracoscopic group in the same period.Through femoral artery,vein and internal jugular vein cannulation,extracorporeal circulation was established in both groups.The perioperative situation,operation related data and postoperative follow-up were compared between two groups.Results ASD repair closures were successfully performed without in-hospital mortality or other serious complications in both groups.Regression analysis and learning curve showed that in 47 cases of modified robot-assisted ASD repair under beating-heart,the learning curve for operation time was y=302-41.79 ln(x)(r2=0.904,P<0.01),and the learning curve for CPB time was y=162-40.684 ln(x)(r2=0.877,P<0.01).There were 12 cases(48.00%) of undergoing tricuspid valvuloplasty simultaneously in modified robot group and 11 cases(40.74%) in 3 D thoracoscopic group(P>0.05).CPB duration and postoperative ventilator support time in modified robot group were lower than those in 3 D thoracoscopic group,and the operation time was longer than that in 3 D thoracoscopic group(P<0.05,P<0.01).There were no significant differences in ICU stay time,postoperative drainage volume and length of hospital stay between two groups(all P>0.05).During postoperative follow-up,no residual shunt or tricuspid regurgitation oc

关 键 词：达芬奇外科手术系统 房间隔缺损 先天性心脏病 学习曲线 

分 类 号：R616[医药卫生—外科学] R654.2[医药卫生—临床医学]