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机器人心脏不停跳下冠状动脉旁路移植术后中远期随访及其影响因素的研究

发布时间:2019-01-10 18:35  文章来源:笔耕文化传播
【摘要】:目的研究机器人心脏不停跳下冠脉旁路移植术中远期桥血管通畅率、MACCE事件发生率及生存率及其影响因素。方法1.研究对象:回顾性分析2007年1月至2014年12月我院完成机器人心脏不停跳下冠脉旁路移植术患者的临床资料。其中,机器人乳内动脉游离+胸壁小切口下冠状动脉旁路移植术(minimally invasive direct coronary artery bypass, MIDCAB)病人140例;全机器人下冠状动脉旁路移植术(totally endoscopic coronary bypass, TECAB)病人100例;所有手术均在心脏跳动下进行,对部分血管多支病变病人,术后行机器人分站式杂交手术。2.手术方法:MIDCAB组:常规手术准备后,行双腔气管插管,右侧单肺通气,左侧胸壁打孔后连接da Vinci机器人系统,机器人辅助游离乳内动脉后,行胸壁6cm小切口进胸,直视下手工吻合乳内动脉于靶血管;TECAB组:全机器人下游离乳内动脉并将乳内动脉与靶血管吻合。两组患者术中应用VeriQC系统(Medistim ASA, Norway)测量桥血流。3.术后处理所有患者术后常规进入CCU单元治疗,病情好转后转入普通病房继续治疗,多支血管病变患者,术后2周内行支架置入术。出院前,TECAB组行冠脉造影,MIDCAB组行螺旋CT,明确桥血管通畅情况。4.随访情况TECAB组随访时间40.5+22.5月(3~95月),成功随访92人,随访率92.0%,MIDCAB组随访时间41.2+29.1月(1~97月)成功随访128人,随访率91.4%。结果1. TECAB组乳内动脉使用率100%,桥血流34.5±20.1ml/min,1例因靶血管钙化严重,分支出血较多,暴露困难,改为MIDCAB,1例全镜下再次探查止血,1例术后早期心肌梗塞(无临床症状),术后2周冠脉造影提示桥血管通畅;MIDCAB组3例应用双侧乳内动脉,其余应用单侧乳内动脉,桥血流21.8±13.7ml/min,无术中死亡,无危及生命的严重并发症。2. TECAB组17例行分站式杂交手术;MIDCAB组16例行分站式杂交手术。3. TECAB组术后半年、1年、3年、3年以上桥血管通畅率分别为100%,98.86%,98.86%,98.86%;MIDCAB组术后半年、1年、3年、3年以上年桥血管通畅率分别100%,98.78%,97.54%,97.54%。4. TECAB组随访期间6例发生MACCE事件,死亡5例,再血管化1例;MIDCAB组2例发生MACCE事件,均为再血管化。5. TECAB组术后1年、3年、5年、8年生存率分别为98.91%,96.74%,94.54%,94.54%;MIDCAB组术后1年、3年、5年、8年生存率均为100%。结论1.TECAB组和MIDCAB组术后中远期桥血管通畅率及术后远期生存率高、MACCE事件发生率低,疗效均值得肯定。2. TECAB术式及MIDCAB术式安全性及可行性较好,是值得选择的良好微创手术方式。
[Abstract]:Objective to study the patency rate, the incidence of MACCE events, survival rate and its influencing factors in the long term graft after robotic heart beating coronary artery bypass grafting. Method 1. Participants: the clinical data of patients undergoing coronary artery bypass grafting in our hospital from January 2007 to December 2014 were retrospectively analyzed. There were 140 patients with (minimally invasive direct coronary artery bypass, MIDCAB) and 100 patients with (totally endoscopic coronary bypass, TECAB) after intracoronary artery free small incision coronary artery bypass grafting. All the operations were performed under the beating of the heart. Operation methods: MIDCAB group: after routine operation preparation, double lumen tracheal intubation, right lung ventilation, left chest wall perforation connected with da Vinci robot system, robot-assisted free internal mammary artery, chest wall 6cm small incision were performed. The intramammary artery was manually anastomosed to the target vessel under direct vision. In TECAB group, the internal mammary artery was free and anastomosed with the target vessel. The blood flow of the bridge was measured by VeriQC system (Medistim ASA, Norway) in both groups. 3. 3%. All the patients were treated with CCU unit therapy after operation, the patients were transferred to the general ward after the improvement of the condition, and the patients with multi-vessel disease were treated with stent implantation within 2 weeks after operation. Before discharge, coronary angiography was performed in TECAB group and spiral CT, was performed in MIDCAB group. 4. 4. The follow-up time of TECAB group was 40.5 22.5 months (3 ~ 95 months), and 92 cases were followed up successfully. The follow-up rate of 92.0 MIDCAB group was 41.21 months (1-97 months), and the follow-up rate was 91.4. Result 1. In the TECAB group, the utilization rate of the internal mammary artery was 100 and the blood flow of the bridge was 34.5 卤20.1 ml / min. Because of the severe calcification of the target vessel, the hemorrhage of the branches was more severe, and the exposure was difficult. 1 case had early myocardial infarction (no clinical symptoms), 2 weeks after the operation, coronary angiography indicated the patency of the grafts. In MIDCAB group, 3 cases were treated with bilateral internal mammary artery and others with unilateral internal mammary artery. The blood flow of the bridge was 21.8 卤13.7 ml / min. There was no intraoperative death and no serious life-threatening complications. 2. TECAB group (17 cases) and MIDCAB group (16 cases). The patency rates of grafts in TECAB group were 98.86 and 98.86, respectively, half a year, one year, three years and more than three years after operation. In the MIDCAB group, the patency rate of the grafts was 98.78 and 97.547.54, respectively, half a year, one year, three years and more than three years after operation. In TECAB group, 6 cases had MACCE event, 5 cases died and 1 case had re-vascularization, and 2 cases in MIDCAB group had MACCE event, all of which were re-vascularization. The 1 year, 3 year, 5 year and 8 year survival rates of TECAB group were 98.91%, 96.74% and 94.54%, respectively. The survival rates of 1 year, 3 years, 5 years and 8 years after operation in MIDCAB group were 100. Conclusion the middle and long term graft patency rate, long term survival rate and low incidence of MACCE events in 1.TECAB group and MIDCAB group are all worthy of recognition. 2. TECAB and MIDCAB are safe and feasible, which is a good minimally invasive operation.
【学位授予单位】:中国人民解放军医学院
【学位级别】:硕士
【学位授予年份】:2015
【分类号】:R654.2

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