机器人辅助冠状动脉旁路移植术:252例单中心经验  

Robot-assisted coronary artery bypass grafting:a single-center experience of 252 cases

作　　者：李伊宁 傅元豪[1] 丁通 孟鲁豫 宫一宸[1] 吴松[1] 凌云鹏[1] Li Yining;Fu Yuanhao;Ding Tong;Meng Luyu;Gong Yichen;Wu Song;Ling Yunpeng(Department of Cardiovascular Surgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院心脏外科,北京100191

出　　处：《中华胸心血管外科杂志》2025年第1期16-21,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评价机器人辅助冠状动脉旁路移植术的安全性和有效性。方法回顾性分析2021年4月至2023年8月北京大学第三医院心脏外科中心连续进行的252例机器人辅助冠状动脉旁路移植术患者的临床资料。利用机器人手术系统骨骼化获取乳内动脉,撤去机器人后,经左胸前外侧肋间4~6 cm小切口完成旁路移植血管和靶血管吻合等操作。出院前常规行控制性冠状动脉造影或冠状动脉CTA复查。结果149例(59.1%)患者接受多支冠状动脉旁路移植,140例(55.6%)接受全动脉化旁路移植,131例(52.0%)为原位双乳内动脉旁路移植,乳内动脉获取失败6例(1.6%)。接受体外循环辅助1例(0.4%),术后再次开胸5例(2.0%)。复查旁路移植血管通畅率为96.6%(449/465)。12个月生存率为97.8%,24个月生存率为96.5%;12个月免于MACCE生存率为95.2%,24个月免于MACCE生存率为92.6%。结论机器人辅助冠状动脉旁路移植手术安全可行,机器人辅助下可以获取原位双乳内动脉并实现对各靶血管区域的血运重建,该结论需要中长期随访进一步证实。ObjectiveTo evaluate the safety and effectiveness of robot-assisted coronary artery bypass(RACAB).MethodsWe retrospectively analyzed the clinical outcomes from 252 consecutive patients who underwent RACAB in our center between April 2021 and August 2023.The internal mammary artery(IMA)was harvested using the skeletonized technique with the assistance of the robotic system.Then,graft-to-target vessel anastomoses were performed via a 4-6 cm left fifth intercostal thoracotomy.Coronary angiography or coronary CTA was routinely performed before discharge.Results149 patients(59.1%)underwent multi-vessel coronary bypass.140 patients(55.6%)underwent total arterial bypass grafting,with 131 patients(52.0%)undergoing RACAB with in situ bilateral IMA.IMA harvesting failed in 6 patients(1.6%).One patient(0.4%)was assisted by extracorporeal circulation,and 5 patients(2.0%)underwent re-thoracotomy postoperatively.The patency rate of grafts was 96.6%(449/465).The 12-month and 24-month survival rate were 97.8%and 96.5%respectively;The 12-month and 24-month MACCE-free survival rate were 95.2%and 92.6%,respectively.ConclusionRACAB is safe and feasible.With the assistance of the robotic system,in situ bilateral IMA can be obtained and bypassed to all target vessels territory.Extended follow-up is warranted.

关 键 词：冠状动脉旁路移植术 全动脉化 原位双乳内动脉 微创冠状动脉旁路移植术 机器人手术 

分 类 号：R654.2[医药卫生—外科学]