摘要目的 总结机器人二尖瓣成形术的临床应用,以评估其安全性及有效性.方法 自2007年1月至2011年4月,对60例患者行机器人二尖瓣成形术,其中男性42例,女性18例;年龄14～70岁,平均年龄(44±13)岁.14例患者术前合并心房颤动.术前心功能(NYHA分级)Ⅰ～Ⅱ级48例,Ⅲ级12例.股动静脉及右侧颈内静脉插管建立心肺转流.于右侧胸壁经肋间插入3个直径为0.8 cm的器械臂,并于第4肋间打1个直径为1.5 cm的工作孔.术者于操作台前、三维成像系统下遥控微创器械完成二尖瓣成形术.术中经食管超声引导建立心肺转流并评估手术效果,术后常规进行随访.结果 平均心肺转流时间(132 ±30)min,主动脉阻断时间(88±22)min.1例患者术后出现重度溶血,再次手术行生物瓣置换后治愈.无手术死亡及中转开放手术.平均随访(16±9)个月,2例患者术后存在轻度反流.结论 达芬奇机器人二尖瓣成形术安全有效,手术效果良好.而且手术视野清晰,结构暴露好,是可供选择的良好微创术式.

abstractsObjective To determine the safety and efficacy of robotic mitral valve repair using da Vinci S Surgical system.Method From January 2007 to April 2011,over 400 cases of robotic cardiac surgery have been performed,in which 60 patients with isolated mitral valve insufficiency underwent robotic mitral valve repair,including 42 male and 18 female patients with a mean age of(44 ±13)years(ranging from 14 to 70 years).Forty-eight patients were in NYHA class Ⅰ-Ⅱ and 12 patients in class Ⅲ.Fourteen patients were concomitant with atiral fibrillation.Surgery approach was achieved through 4 right chest ports with femoral perfusion and Chitwood aortic occlusion.Antegrade cold blood cardioplegia was administered directly via chest for myocardial protection.The transesophageal echocardiography was used intraoperatively to estimate the surgical results.Results All patients had successful valve repair including quadrangular resections,sliding plasties and chordal replacement.There was no conversion to median sternotomy.The mean cardiopulmonary bypass and arrested heart time were(132 ±30)min and(88±22)min.One patient had hemolysis after operation,and required mitral valve replacement Echocardiographic follow-up revealed trace to mild regurgitation in 2 patients with a mean of(16±9)months.Conclusion Robotic mitral valve repair is safe and efficacious in the patients with isolated mitral valve insufficiency.