摘要目的 总结"达芬奇S"(da Vinic S)机器人下非体外循环冠状动脉旁路移植与支架置入杂交手术技术特点和优势.方法 2007年1～8月使用da Vinic S机器人系统,完成非体外循环冠状动脉旁路移植共42例,其中10例因双支冠脉病变,在机器人旁路手术后行支架置入术.病人平均年龄为(62.3±12.1)岁,其中男8例,女2例.病人冠状动脉造影均显示严重的前降支病变,并合并有回旋支或右冠状动脉的局限性狭窄.所有病人肺功能良好,无胸膜炎和左侧胸腔手术史.机器人手术过程中无需正中开胸,仅左侧胸壁打直径为1 cm的器械臂孔3个,术者于da Vinic S系统的操作台前、三维成像系统下遥控机器人全程游离乳内动脉;其中4例直接行全机器人非体外行循环下冠状动脉旁路移植术(TECAB),另6例于左侧胸壁第4肋间作6～8cm的小切口,在心脏跳动下行乳内动脉和前降支的吻合(SVST).术后1周左右经股动脉常规行回旋支或右冠状动脉支架置入术.置入术中行乳内动脉造影评价再血管化效果.结果 病人术后恢复顺利,并成功接受支架置入术,乳内动脉旁路血管通畅,无并发症发生.结论 应用机器人微创冠脉旁路手术和支架置入杂交手术治疗冠心病,可最大限度的减小手术创伤并实现完全再血管化.

abstractsObjective To summarize the first group of off-pump robotic bypass surgeries and stent placement in distinct hybrid session in China. Methods Forty-two patients underwent selective robotic coronary bypass grafting on the beating heart from April 2007 to August 2008. Ten cases with right coronary artery or circumflexc circumflex coronary stenosis received stent placement after roboti surgery in a hybrid manner. The average age of patients was (62.3±12.1) yeas old. Two cases were female and 8 male. All the patients had histocy of anagina. The coronary arteriography showed significant stenosis in the left anterior descending branch in all patients before surgery. And 4 cases had history of myocardial infraction. Lung functions of all the patients were normal and no patient had history of pleurisy. Without sternotomy, through 3 ports about 1 cm in the left thorax, the left internal mammary artety was harvested by da Vinci S robotic system, and simultaneously single vessel coronary artery bypass grafting via small thoracotomy(SVST)or totally endoscopic coronary bypass (TECAB) was performed off-pump. Then percutaneous coronary intervention was performed shout 1 week after the operation and the IMA graft patency was assessed at the same time. Results All patients had gone through off-pump robotic bypass surgery and stent placement in distinct hybrid session without complications. Conclusion Hybrid coronary artery revascularization enables total revascularization in patients with multivessel coronary artery disease without sternotomy.