南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (11): 1557-1563.doi: 10.12122/j.issn.1673-4254.2020.11.04

• • 上一篇    下一篇

机器人辅助与胸骨正中切开二尖瓣置换术的生活质量及远期疗效比较

赵海智，张华军，杨 明，肖苍松，王 瑶，高长青，王 嵘   

  • 出版日期:2020-11-20 发布日期:2020-11-23

Comparison of quality of life and long-term outcomes following mitral valve replacement through robotically assisted versus median sternotomy approach

  • Online:2020-11-20 Published:2020-11-23

RichHTML

36

HTML

PDF

307

摘要： 目的 总结并对比分析机器人二尖瓣置换和常规开胸二尖瓣置换相关手术指标和术后的生活质量、伤口满意度及术后恢复时长。方法 回顾性收集 2007 年 1 月~ 2015 年 12 月我院47例接受 da Vinci 机器人二尖瓣置换术的患者的资料，并以此47例患者作为机器人组。2002 年3 月~2014 年6 月正中开胸二尖瓣置换手术患者共286 例，依据7 个指标从正中开胸患者中抽取 47 例作为开胸组进行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，使用生活质量调查量表（SF-12）调查术30 d、半年的生活质量，同时对比两组患者术后恢复工作时间和对手术切口的满意度。结果 机器人组和开胸组的患者均成功完成二尖瓣置换手术，术中未见患者死亡。机器人组术后并发症仅有 1 例为胸腔积液。开胸组患者中1 例因术后引流过多接受二次开胸止血，1 例患者术后死于感染性休克。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（P<0.05）。两组患者术后并发症的发生率无明显区别。术后30 d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。术后患者对于切口的满意程度，机器人组明显优于开胸组（P<0.001）。术后半年随访患者工作生活恢复情况，机器人组明显快于开胸组。结论 机器人二尖瓣置换手术效果可靠，机器人组对比开胸组手术创伤更小，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。

关键词: 微创外科, 机器人, 二尖瓣手术, 生活质量

Abstract: Objective To compare the mid- and long-term outcomes of patients receiving mitral valve replacement through robotically assisted and conventional median sternotomy approach. Methods The data of 47 patients who underwent da Vinci robotic mitral valve replacement in our hospital between January, 2007 and December, 2015 were collected retrospectively (robotic group). From a total of 286 patients undergoing mitral valve replacement through the median thoracotomy approach between March, 2002 and June, 2014, 47 patients were selected as the median sternotomy group for matching with the robotic group at a 1∶1 ratio. The perioperative data and follow-up data of the patients were collected, and the quality of life (QOL) of the patients at 30 days and 6 months was evaluated using the Quality of Life Short Form Survey (SF-12). The time of returning to work postoperatively and the patients' satisfaction with the surgical incision were compared between the two groups. Results All the patients in both groups completed mitral valve replacement successfully, and no death occurred during the operation. In the robotic group, only one patient experienced postoperative complication (pleural effusion); in median sternotomy group, one patient received a secondary thoracotomy for management of bleeding resulting from excessive postoperative drainage, and one patient died of septic shock after the operation. The volume of postoperative drainage, postoperative monitoring time, ventilation time, and postoperative hospital stay were significantly smaller or shorter in the robotic group than in the thoracotomy group (P<0.05). There was no significant difference in the incidence of postoperativecomplications between the two groups. Assessment of the patients at 30 days after the operation showed a better quality of life in the robotic group, but the difference between the two groups tended to diminish at 6 months. The patients in the robotic group reported significantly better satisfaction with the incision than those in the thoracotomy group (P<0.001). At 6 months after the operation, the patients in the robotic group showed significantly faster recovery of work and daily activities than
those in the thoracotomy group. Conclusion Robotically assisted mitral valve replacement is safe and reliable. Compared with the median sternotomy approach, the robotic approach is less invasive and promotes faster postoperative recovery of the patients, who have better satisfaction with the quality of life and wound recovery.

Key words: minimally invasive surgery, robotically assisted surgery, mitral valve surgery, quality of life