本文關(guān)鍵詞： 微創(chuàng)外科 機(jī)器人 二尖瓣手術(shù) 心功能 生活質(zhì)量 隨訪　出處：《中國人民解放軍醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：(1)研究機(jī)器人二尖瓣置換手術(shù)的臨床資料,總結(jié)分析解放軍總醫(yī)院心血管外科行機(jī)器人二尖瓣置換手術(shù)治療瓣膜性心臟病的臨床經(jīng)驗(yàn),并隨訪患者術(shù)后恢復(fù)情況。(2)通過比較機(jī)器人二尖瓣置換術(shù)與正中開胸二尖瓣置換術(shù)的臨床資料及術(shù)后隨訪情況,評價(jià)機(jī)器人二尖瓣置換術(shù)的安全性、有效性及術(shù)后生活質(zhì)量,為臨床合理選擇手術(shù)方式提供依據(jù)。方法：(1)回顧性收集2007年1月至2015年12月解放軍總醫(yī)院心血管外科47例接受da Vinci機(jī)器人二尖瓣置換術(shù)的患者的資料。通過隨訪患者出院后心臟超聲資料,對比分析患者的近期手術(shù)效果,分析機(jī)器人二尖瓣置換的療效。同時(shí)對比體外循環(huán)和阻斷時(shí)間隨手術(shù)例數(shù)累積的變化,繪制手術(shù)的學(xué)習(xí)曲線圖。(2)以第一部分的47例患者作為機(jī)器人組。依據(jù)七個(gè)指標(biāo)：術(shù)前NYHA紐約心功能等級、病變類型及程度、術(shù)前Euro-Score Ⅱ評分、LVEF、年齡、性別和人工瓣類型從正中開胸患者中抽取47例作為正中開胸二尖瓣置換組進(jìn)行1：1配對。通過收集圍術(shù)期相關(guān)資料,隨訪患者出院后臨床資料,對比患者心臟超聲及NYHA心功能分級以評估心功能變化。同時(shí)使用生活質(zhì)量調(diào)查量表(SF-12)調(diào)查術(shù)30天、半年的生活質(zhì)量。結(jié)果：(1)所有患者成功完成機(jī)器人二尖瓣置換手術(shù)。術(shù)后并發(fā)癥僅有1例(2.12%)為胸腔積液,胸腔閉式引流后恢復(fù)佳。所有患者出院前復(fù)查心臟超聲均效果良好,未見瓣周漏、左室流出道梗阻或人工瓣功能受限等并發(fā)癥。47例患者恢復(fù)順利出院。出院后隨訪6-88個(gè)月,隨訪患者41例(87.2%),所有患者均恢復(fù)良好,心功能Ⅰ級至Ⅱ級為主,未見明顯并發(fā)癥。術(shù)后心臟超聲左房內(nèi)徑明顯減小(P0.05),左室舒張末徑和射血分?jǐn)?shù)變化不明顯。此外,機(jī)器人心臟手術(shù)的體外循環(huán)時(shí)間和阻斷時(shí)間符合學(xué)習(xí)曲線的規(guī)律,隨著例數(shù)的增加時(shí)間逐漸縮短。(2)機(jī)器人組和正中開胸的患者在基線資料上一致,具有可比性。在手術(shù)輸血量、術(shù)后引流量、術(shù)后監(jiān)護(hù)時(shí)間、呼吸機(jī)時(shí)間及術(shù)后住院時(shí)間上,機(jī)器人組均優(yōu)于正中開胸組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者均無術(shù)中死亡,術(shù)后并發(fā)癥的發(fā)生率亦無明顯區(qū)別。機(jī)器人手術(shù)的體外循環(huán)時(shí)間(122.02±25.45min)及主動脈阻斷時(shí)間(85.68±20.70min)均較正中開胸組延長(P0.001)。術(shù)后30天生活質(zhì)量調(diào)查(SF-12)顯示機(jī)器人組有明顯的優(yōu)勢,但在半年后兩組趨于一致。隨訪術(shù)后1-5年,心臟超聲及NYHA心功能分級的結(jié)果示機(jī)器人組心功能情況較術(shù)前改善明顯(P0.05),與正中開胸組相比結(jié)果一致。結(jié)論：機(jī)器人二尖瓣置換手術(shù)效果可靠,術(shù)后隨訪結(jié)果提示心功能良好。機(jī)器人組對比正中開胸組中遠(yuǎn)期效果相似,同時(shí)手術(shù)創(chuàng)傷更小,術(shù)后恢復(fù)更快,對于生活質(zhì)量及傷口恢復(fù)更滿意,是可供選擇的良好微創(chuàng)手術(shù)方式。
[Abstract]:Objective: (1) clinical data of robotic mitral valve replacement surgery, summarize the clinical experience of PLA General Hospital of cardiovascular surgery robotic mitral valve replacement surgery treatment of valvular heart disease, and follow-up of patients with postoperative recovery. (2) followed by comparison of clinical data of robot two tricuspid valve replacement and median thoracotomy mitral valve replacement and postoperative evaluation of safety of robotic mitral valve replacement surgery, efficacy and postoperative life quality, provide the basis for reasonable selection of surgical methods in clinic. Methods: (1) review of cardiovascular surgery from January 2007 to December 2015, PLA General Hospital, 47 patients received Da Vinci robotic mitral valve replacement patients. The echocardiographic follow-up of patients after discharge, comparative analysis of effect of recent surgery, analysis of the effect of mitral valve replacement on the robot. At the same time than extracorporeal circulation Ring and the blocking time varies with the number of surgical cases accumulated, the learning curve drawing operation. (2) in the first part of 47 cases of patients as the robot group. Based on seven indicators: preoperative NYHA New York heart function grade, type and extent of lesion, preoperative Euro-Score score, LVEF, age, and gender artificial valve type from the middle thoracic extraction in 47 patients as median thoracotomy mitral valve replacement group 1:1. Through the collection of relevant information peri operation period, clinical data of patients after discharge, contrast echocardiography and NYHA in patients with heart function to evaluate the heart function changes. At the same time using quality of life questionnaire (SF-12) survey in 30 days, the first half of the quality of life. Results: (1) all patients successfully completed robotic mitral valve replacement surgery. Postoperative complications in only 1 cases (2.12%) for pleural effusion, pleural closed drainage after recovery. All the patients were discharged before complex Echocardiographic effect is good, no paravalvular leakage, left ventricular outflow tract obstruction or prosthetic valve dysfunction and other complications of.47 patients discharged from hospital after recovery. Followed up 6-88 months after discharge, 41 cases (87.2%), all the patients recovered well, heart function grade I to II level for the Lord, no obvious complications. Postoperative echocardiography left atrial diameter was significantly reduced (P0.05), left ventricular end diastolic diameter and ejection fraction did not change significantly. In addition, the time of extracorporeal circulation robotic cardiac surgery and blocking time in accordance with the learning curve, with the increase of the number of cases is gradually shortened. (2) the robot group and the middle the patients in the chest consistent baseline data, comparable. In operative blood transfusion, postoperative drainage, postoperative care time, hospitalization time and postoperative ventilator time, the robot group was better than the thoracotomy group, the difference was statistically significant in two groups (P0.05). There were no intraoperative death, postoperative complication rate no significant difference. Cardiopulmonary bypass time robotic surgery (122.02 + 25.45min) and aortic clamping time (85.68 + 20.70min) were compared with median sternotomy group extension (P0.001). 30 days after operation to investigate the quality of life (SF-12) show that the robot group has obvious the advantage, but in the six months after the two groups tended to be the same. 1-5 years after surgery, the heart functions of ultrasound and NYHA grading showed heart function was significantly improved compared with preoperative robot (P0.05), with a median sternotomy group compared results. Conclusion: robotic mitral valve replacement surgery effect is reliable, postoperative follow up results suggest good heart function. The robot group contrast median thoracotomy group in long-term effect was similar to that at the same time, less surgical trauma, faster postoperative recovery, the quality of life and wound recovery satisfaction, is a good way of minimally invasive surgery for selection.

【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R654.2

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