机器人二尖瓣置换对比正中开胸二尖瓣置换的疗效及中远期随访结果

发布时间：2018-02-28 10:12

本文关键词： 微创外科机器人二尖瓣手术心功能生活质量随访　出处：《中国人民解放军医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的：(1)研究机器人二尖瓣置换手术的临床资料,总结分析解放军总医院心血管外科行机器人二尖瓣置换手术治疗瓣膜性心脏病的临床经验,并随访患者术后恢复情况。(2)通过比较机器人二尖瓣置换术与正中开胸二尖瓣置换术的临床资料及术后随访情况,评价机器人二尖瓣置换术的安全性、有效性及术后生活质量,为临床合理选择手术方式提供依据。方法：(1)回顾性收集2007年1月至2015年12月解放军总医院心血管外科47例接受da Vinci机器人二尖瓣置换术的患者的资料。通过随访患者出院后心脏超声资料,对比分析患者的近期手术效果,分析机器人二尖瓣置换的疗效。同时对比体外循环和阻断时间随手术例数累积的变化,绘制手术的学习曲线图。(2)以第一部分的47例患者作为机器人组。依据七个指标：术前NYHA纽约心功能等级、病变类型及程度、术前Euro-Score Ⅱ评分、LVEF、年龄、性别和人工瓣类型从正中开胸患者中抽取47例作为正中开胸二尖瓣置换组进行1：1配对。通过收集围术期相关资料,随访患者出院后临床资料,对比患者心脏超声及NYHA心功能分级以评估心功能变化。同时使用生活质量调查量表(SF-12)调查术30天、半年的生活质量。结果：(1)所有患者成功完成机器人二尖瓣置换手术。术后并发症仅有1例(2.12%)为胸腔积液,胸腔闭式引流后恢复佳。所有患者出院前复查心脏超声均效果良好,未见瓣周漏、左室流出道梗阻或人工瓣功能受限等并发症。47例患者恢复顺利出院。出院后随访6-88个月,随访患者41例(87.2%),所有患者均恢复良好,心功能Ⅰ级至Ⅱ级为主,未见明显并发症。术后心脏超声左房内径明显减小(P0.05),左室舒张末径和射血分数变化不明显。此外,机器人心脏手术的体外循环时间和阻断时间符合学习曲线的规律,随着例数的增加时间逐渐缩短。(2)机器人组和正中开胸的患者在基线资料上一致,具有可比性。在手术输血量、术后引流量、术后监护时间、呼吸机时间及术后住院时间上,机器人组均优于正中开胸组,差异有统计学意义(P0.05)。两组患者均无术中死亡,术后并发症的发生率亦无明显区别。机器人手术的体外循环时间(122.02±25.45min)及主动脉阻断时间(85.68±20.70min)均较正中开胸组延长(P0.001)。术后30天生活质量调查(SF-12)显示机器人组有明显的优势,但在半年后两组趋于一致。随访术后1-5年,心脏超声及NYHA心功能分级的结果示机器人组心功能情况较术前改善明显(P0.05),与正中开胸组相比结果一致。结论：机器人二尖瓣置换手术效果可靠,术后随访结果提示心功能良好。机器人组对比正中开胸组中远期效果相似,同时手术创伤更小,术后恢复更快,对于生活质量及伤口恢复更满意,是可供选择的良好微创手术方式。
[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.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.2

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