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
成楠，杨明，王明岩，刘冰，申华，郭鹏飞，赵元程，贺田田，许克，王嵘
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。
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.