摘要
目的探讨机器人冠状动脉旁路移植术(CABG)的远期疗效。方法回顾性分析2007年1月-2014年11月240例接受机器人辅助非体外循环冠状动脉旁路移植术患者的临床资料,其中男187例,女53例,平均年龄59岁,全机器人冠状动脉旁路移植术(TECAB)100例,机器人乳内动脉游离+胸壁小切口冠状动脉旁路移植术(MIDCAB)140例。术后每6个月采用冠状动脉造影或64排CT血管造影技术评估桥血管通畅性。结果所有患者均未转为正中开胸或体外循环,共包括237例单侧乳内动脉(IMA)游离和3例双侧IMA游离,无手术死亡。24例(10%)使用杂交技术。术后随访41.1±12.9个月,无死亡、中风或心肌梗死发生。术后随访3年(最长时间91个月)的结果显示,TECAB组IMA移植通畅率为97.1%,MIDCAB组IMA移植通畅率为96.4%。结论机器人辅助的非体外循环冠状动脉旁路移植术对于特定患者是安全、有效的,乳内动脉桥可以保持良好的远期通畅率。
Objective The aim of the study was to explore the long-term benefits of coronary artery bypass grafting（CABG）. Methods From January 2007 to November 2014, 240 patients（187 males and 53 females, average age 59 years） received robotic off-pump CABG assisted with da Vinci Surgical System（Intuitive Surgical, USA） in our center. Totally endoscopic coronary artery bypass（totally robot-assisted TECAB, n=100） or mini-thoracotomy direct coronary artery bypass（free of internal mammary artery, IMA, by robot, MIDCAB, n=140） grafting was performed. Patients were followed-up regularly, and their graft patency was assessed every 6 months by coronary angiography or 64-multi-slide CT angiography. Results All the procedures were completed successfully without conversion to median sternotomy or cardiopulmonary bypass, there was no operative mortality. 237 unilateral IMA grafts（98.7%） and 3 bilateral IMA grafts（1.3%） were used. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients（10%）. In the follow-up of 41.1±12.9 months, no death, stroke or myocardial infarction occurred. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MIDCAB over 3 years（up to 91 months） after surgery. Conclusions Robotic off-pump CABG using IMA grafts is a safe and effective surgery method in selected patients. The long-term outcome and patency of IMA grafts are excellent.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2016年第6期512-517,共6页
Medical Journal of Chinese People's Liberation Army
