术中经食管超声心动图在全机器人膜周部室间隔缺损修补中的作用

Intraoperative Transesophageal Echocardiography in Robotic Perimembranous Ventricular Septal Defect Repair

中文关键词:  超声心动描记术，经食管 微创心脏外科 室间隔缺损修补术

英文关键词:Echocardiography, transesophageal Minimally invasive cardiac surgery VSD repair

中文摘要:

      目的 探讨术中经食管超声心动图 (transesophageal echocardiography, TEE) 在全机器人膜周部室间隔缺损 (ventricular septal defect, VSD) 修补中的作用。方法 对2009年1月至2012年8月间在我院接受全机器人膜周部VSD修补的18例住院患者的术中TEE资料进行回顾性分析。术中应用TEE的时间及目的：① 体外循环 (cardiopulmonary bypass, CPB) 转机前，进一步明确VSD 解剖类型、数目及大小，术者参考上述信息拟定手术方案；② 建立外周CPB 时，引导下、上腔静脉插管及升主动脉内心脏停搏液灌注针的置放；③ 心脏复跳后，即刻评价心室水平有无残余分流及有无手术相关并发症。结果 ①以外科医生术中所见为标准，TEE 诊断VSD 解剖类型的准确性为100％，所有患者修补VSD 均按术前拟定方案进行。②术中证实，所有患者下、上腔静脉内插管及升主动脉内灌注针均放置于适当位置，TEE 引导置管成功率为100％。③心脏复跳后，TEE显示所有患者心室水平均无残余分流，均无手术相关并发症，所有手术均获成功。结论 术中TEE 在全机器人膜周部VSD 修补中是有益的诊断手段。

英文摘要:

      Objective To explore the role of intraoperative transesophageal echocardiography (TEE) in robotic perimembranous ventricular s eptal defect (VSD) repair. Methods A retrospective analysis was conducted with intraoperative TEE data of 18 consecutive patients who underwent robotic perimembranous VSD repair from January 2009 to August 2012. ① Before c ardiopulmonary bypass (CPB), TEE was performed to document the anatomic types, n umbers, and the size of VSD. The procedures were predetermined by the surgeon ac cording to TEE information. ② During the establishment of peripheral CPB, TEE w as used to guide the placement of cannulae in inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). ③ After weaning from CPB, TEE was conducted to evaluate the effect of the procedure. Results ① Accuracy of TEE was 100% for diagnosing the anatomic types of VSD. All the surgi cal procedures were performed based on the predetermined information. ② Under TEE guidance, all the cannulae in the SVC, IVC and AAO were located in correct p ositions. ③ In all patients, TEE confirmed successful VSD repair. Conc lusion TEE is a useful tool in the assessment of robotic perimembrano us VSD repair.