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机器人心脏外科手术早期随访的安全性及有效性研究

关键词： 心脏外科；机器人手术系统；机器人辅助手术；学习曲线

许李力，李平，徐屹，刘硕，陈长城，尤斌   

  • Vol. 2 No. 6 Dec. 2021
  • DIO: 10.12180/j.issn.2096-7721.2021.06.003 发布日期:2022-01-21 阅读数:545
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  • 作者简介:

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目的：评估机器人心脏外科手术的安全性和有效性。方法：选取 2016 年 1 月 ~2020 年 1 月在本院行达芬奇系统进行机器人心脏外科手术的 180 例患者为研究对象，分析其围手术期超声心动图结果、手术时间和体外循环时间等临床关键参数，拟合 CUSUM 曲线和 Kaplan-Meier 生存曲线，评估机器人心脏外科手术的安全性及有效性。结果：达芬奇机器人心外手术体外循环主动脉阻断手术平均手术时间（5.3±1.2）h，体外循环时间（160.9±56.1）min，主动脉阻断时间（104.8±54.7）min。体外循环非停跳手术平均手术时间（4.5±0.9）h，体外循环时间（104.8±54.7）min。非体外循环不停跳搭桥手术平均手术时间（4.6±0.9）h，乳内动脉制备时间（61.3±23.3）min。围手术期死亡 3例，死亡率 1.67%。随访总时间为 5 389 个月，无术后死亡病例。二尖瓣成形例数 99 例，有 2 例一年以上随访患者出现中度以上反流，二尖瓣成形无临床终止事件成功率 96.2%。根据主动脉阻断时间和体外循环（Cardiopulmonarybypass，CPB）时间 CUSUM 曲线，平均手术 25 例后可以跨越学习曲线。结论：机器人心脏外科体外循环手术是安全和有效的。研究结果表明，随着经验的增加，克服学习曲线后，手术时间和体外循环时间可以缩短；且机器人手术在某些需要精细操作的手术中有较大的优势。

Objective: To evaluate the safety and effectiveness of robotic cardiac surgery. Methods: A total of 180 patients who underwent Da Vinci robotic cardiac surgery from January 2016 to January 2020 were selected. The results of perioperative echocardiography, operation time, extracorporeal circulation time and other clinical key parameters were analyzed, the CUSUM curve and Kaplan-Meier survival curve were fitted to evaluate the safety and effectiveness. Results: The average operation time of robotic cardiac surgery was 5.3±1.2 h, cardiopulmonary bypass time was 160.9±56.1 min and aortic occlusion time was 104.8±54.7 min. The average operation time of non-stop operation with cardiopulmonary bypass was 4.5±0.9 h and the time of cardiopulmonary bypass was 104.8±54.7 min. The average operation time of off-pump bypass grafting was 4.6±0.9, and the internal mammary artery preparation time was 61.3±23.3 min. Three cases died during the perioperative period with a mortality rate of 1.67%. The total follow-up time was 5 389 months and no postoperative death was found. There were 99 cases of mitral valve repair, of which two patients with more than one year follow-up had moderate or above regurgitation. The success rate of mitral valve repair without clinical termination event was 96.2%. According to the CUSUM curve of aortic block time and CPB time, the learning curve can be crossed after an average of 25 cases of robotic surgery. Conclusion: Robotic cardiac surgery is safe and effective. The operation time and cardiopulmonary bypass time can be shortened that with the increase of experience after overcoming the learning curve. Robotic surgery has greater advantage in some delicate surgeries.