機(jī)器人心臟不停跳下冠狀動(dòng)脈旁路移植術(shù)后中遠(yuǎn)期隨訪及其影響因素的研究
發(fā)布時(shí)間：2019-01-10 18:35
【摘要】：目的研究機(jī)器人心臟不停跳下冠脈旁路移植術(shù)中遠(yuǎn)期橋血管通暢率、MACCE事件發(fā)生率及生存率及其影響因素。方法1.研究對(duì)象：回顧性分析2007年1月至2014年12月我院完成機(jī)器人心臟不停跳下冠脈旁路移植術(shù)患者的臨床資料。其中,機(jī)器人乳內(nèi)動(dòng)脈游離+胸壁小切口下冠狀動(dòng)脈旁路移植術(shù)(minimally invasive direct coronary artery bypass, MIDCAB)病人140例；全機(jī)器人下冠狀動(dòng)脈旁路移植術(shù)(totally endoscopic coronary bypass, TECAB)病人100例；所有手術(shù)均在心臟跳動(dòng)下進(jìn)行,對(duì)部分血管多支病變病人,術(shù)后行機(jī)器人分站式雜交手術(shù)。2.手術(shù)方法：MIDCAB組：常規(guī)手術(shù)準(zhǔn)備后,行雙腔氣管插管,右側(cè)單肺通氣,左側(cè)胸壁打孔后連接da Vinci機(jī)器人系統(tǒng),機(jī)器人輔助游離乳內(nèi)動(dòng)脈后,行胸壁6cm小切口進(jìn)胸,直視下手工吻合乳內(nèi)動(dòng)脈于靶血管；TECAB組：全機(jī)器人下游離乳內(nèi)動(dòng)脈并將乳內(nèi)動(dòng)脈與靶血管吻合。兩組患者術(shù)中應(yīng)用VeriQC系統(tǒng)(Medistim ASA, Norway)測(cè)量橋血流。3.術(shù)后處理所有患者術(shù)后常規(guī)進(jìn)入CCU單元治療,病情好轉(zhuǎn)后轉(zhuǎn)入普通病房繼續(xù)治療,多支血管病變患者,術(shù)后2周內(nèi)行支架置入術(shù)。出院前,TECAB組行冠脈造影,MIDCAB組行螺旋CT,明確橋血管通暢情況。4.隨訪情況TECAB組隨訪時(shí)間40.5+22.5月(3～95月),成功隨訪92人,隨訪率92.0%,MIDCAB組隨訪時(shí)間41.2+29.1月(1～97月)成功隨訪128人,隨訪率91.4%。結(jié)果1. TECAB組乳內(nèi)動(dòng)脈使用率100%,橋血流34.5±20.1ml/min,1例因靶血管鈣化嚴(yán)重,分支出血較多,暴露困難,改為MIDCAB,1例全鏡下再次探查止血,1例術(shù)后早期心肌梗塞(無(wú)臨床癥狀),術(shù)后2周冠脈造影提示橋血管通暢；MIDCAB組3例應(yīng)用雙側(cè)乳內(nèi)動(dòng)脈,其余應(yīng)用單側(cè)乳內(nèi)動(dòng)脈,橋血流21.8±13.7ml/min,無(wú)術(shù)中死亡,無(wú)危及生命的嚴(yán)重并發(fā)癥。2. TECAB組17例行分站式雜交手術(shù)；MIDCAB組16例行分站式雜交手術(shù)。3. TECAB組術(shù)后半年、1年、3年、3年以上橋血管通暢率分別為100%,98.86%,98.86%,98.86%；MIDCAB組術(shù)后半年、1年、3年、3年以上年橋血管通暢率分別100%,98.78%,97.54%,97.54%。4. TECAB組隨訪期間6例發(fā)生MACCE事件,死亡5例,再血管化1例；MIDCAB組2例發(fā)生MACCE事件,均為再血管化。5. TECAB組術(shù)后1年、3年、5年、8年生存率分別為98.91%,96.74%,94.54%,94.54%；MIDCAB組術(shù)后1年、3年、5年、8年生存率均為100%。結(jié)論1.TECAB組和MIDCAB組術(shù)后中遠(yuǎn)期橋血管通暢率及術(shù)后遠(yuǎn)期生存率高、MACCE事件發(fā)生率低,療效均值得肯定。2. TECAB術(shù)式及MIDCAB術(shù)式安全性及可行性較好,是值得選擇的良好微創(chuàng)手術(shù)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 鹵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 鹵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.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2
[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 鹵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 鹵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.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2
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