摘要目的 探讨达芬奇机器人手术系统辅助髂股静脉旁路移植术的临床疗效.方法 采用回顾性描述性研究方法.收集2019年3月陆军军医大学第一附属医院收治的1例行达芬奇机器人手术系统辅助髂股静脉旁路移植术患者的临床资料.66岁男性患者,因髂股静脉支架内血栓形成腔内治疗无效,在球囊预阻断髂总静脉后行达芬奇机器人手术系统辅助髂股静脉旁路移植术.观察指标:(1)术中及术后情况.(2)随访及生存情况.采用门诊方式进行随访,了解患者术后生存情况和下肢肿胀减退情况.随访时间截至2019年4月.结果 (1)术中及术后情况:患者成功行达芬奇机器人手术系统辅助髂股静脉旁路移植术.数字减影血管造影预置球囊阻断术手术时间为35 min,达芬奇机器人手术系统辅助髂股静脉旁路移植术手术时间为502 min(股静脉暴露时间为50 min、下髂静脉暴露时间为80 min、大隐静脉取材时间为40 min、自体大隐静脉-股静脉端-侧吻合时间为70 min、皮下隧道建立时间为10 min、自体大隐静脉-髂静脉端-侧吻合时间为90 min、除血管缝合以外的缝合时间为60 min、准备时间和检查冲洗时间为102 min).患者术中出血量约500 mL,无术中并发症发生.自体大隐静脉-股静脉端-侧吻合口及自体大隐静脉-髂静脉端-侧吻合口吻合良好,松开所有阻断后无明显渗血.腹部戳孔共4个(1.2 cm戳孔2个、0.8 cm戳孔2个).右侧腹股沟切口长度约5.0 cm,左侧大隐静脉取材区切口长度约15.0 cm.术后至出院时,患者右下肢肿胀部分消退,皮肤张力较入院时明显降低;右膝关节上15 cm周径53.5 em,左膝关节上15 cm周径48.0 em;右小腿最大周径41.0 cm,左小腿最大周径38.0 cm.患者无术后并发症发生.患者术后住院时间为3d.(2)随访及生存情况:患者术后随访1个月,生存良好.术后1个月门诊随诊时患者右下肢肿胀消退,皮肤张力基本正常;右膝关节上15 cm周径52.0 em,左膝关节上15 em周径48.0 cm;右小腿最大周径40.0 cm,左小腿最大周径38.0 em.结论 达芬奇机器人手术系统辅助髂股静脉旁路移植术安全可行,近期疗效较好.

abstractsObjective To explore the clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting.Methods The retrospective descriptive study was conducted.The clinical data of one 66-year-old male patient who underwent Da Vinci robot-assisted iliofemoral vein bypass grafting in the First Affiliated Hospital of Army Military Medical University in March 2019 were collected.The patient was failed to recanalize iliofemoral vein stent thrombosis by endovascular measures and underwent Da Vinci robot-assisted iliofemoral vein bypass grafting after balloon occlusion preset in the common iliac vein.Observation indicators:(1) intra-and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the patient's postoperative survival and swelling reduction of affected extremity up to April 2019.Results (1) Intra-and post-operative situations:the patient underwent Da Vinci robot-assisted iliofemoral vein bypass grafting successfully.The operation time of balloon occlusion preset by digital subtraction angiography was 35 minutes.The operation time of Da Vinci robot-assisted iliofemoral vein bypass grafting was 502 minutes (50 minutes of exposure time of femoral vein,80 minutes of exposure time of iliac vein,40 minutes of great saphenous vein harvesting time,70 minutes of end to side anastomosis between autogenous great saphenous vein and femoral vein,10 minutes of subcutaneous tunnel construction,90 minutes of end to side anastomosis between autogenous great saphenous vein and iliac vein,60 minutes of suturing except vessel closure,102 minutes of preparation time,check and washing time).The volume of intraoperative blood loss was 500 mL and no intraoperative complications occurred.The autogenous great saphenous vein graft was well filled and no bleeding was found at both proximal and distal anastomoses after iliofemoral vein bypass grafting.There were 4 abdominal Trocar holes including 2 of 1.2 cm and 2 of 0.8 cm.The incisional length of right groin and left great saphenous vein harvesting region was 5.0 cm and 15.0 cm,respectively.At the discharge time,the patient had swelling subsided partially at right lower extremity and skin tesion reduced significantly compared with the admission.The perimeters at 15 cm above right knee joint and left knee joint were 53.5 cm and 48.0 cm.The maximum perimeters of right calf and left calf were 41.0 cm and 38.0 cm.No postoperative complications occurred.Duration of hospital stay after surgery was 3 days.(2) Follow-up and survival situations:the patient was followed up for 1 month,with good survival.The patient had swelling subsided of affected extremity.The perimeters at 15 cm above right and left knee joint were 52.0 cm and 48.0 cm.The maximum perimeters of right calf and left calf were 40.0 cm and 38.0 cm.Conclusion The Da Vinci robot-assisted iliofemoral vein bypass grafting is safe and feasible,with good short-term outcomes.