达芬奇机器人辅助与常规开胸二尖瓣置换术的临床疗效对比研究
Comparative Study of Clinical Effects of Da Vinci Robot-Assisted and Conventional Thoracotomy Mitral Valve Replacement

目的：通过对比研究达芬奇机器人辅助与常规开胸二尖瓣置换术下患者的临床治疗效果，进一步明确达芬奇机器人手术系统在二尖瓣置换手术中的优缺点，为其在心脏外科手术中的应用提供一定的数据支持及改进方向。方法：收集我院自2018年1月至2022年1月施行的二尖瓣置换手术患者282例，其中达芬奇机器人辅助下二尖瓣置换手术患者70例，命名为达芬奇组；常规开胸二尖瓣置换手术患者212例，命名为常规组。收集两组患者术前基本信息、术中资料及术后并发症的发生率、住院费用等，以及两组病人的症状改善情况，分为改善、无改善、加重。应用SPSS软件及统计学方法分析两组患者以上数据有没有差异，且差异具不具有统计学意义(P值大于或小于0.05)。结果：达芬奇组与常规组患者均顺利完成手术，无院内死亡，康复后出院。达芬奇组(70例)与常规组(212例)在术前基线特征方面无统计学差异(P > 0.05)。达芬奇组患者手术时间、体外循环时间、主动脉阻断时间较常规组明显延长，差异有统计学意义(P < 0.001)。达芬奇组患者术中出血量、术后气管插管时间、术后ICU停留时间、术后胸腔引流量、术后住院时间均较常规组减少，差异有统计学意义(P < 0.001)。两组患者术后并发胸腔积液、切口感染、下肢静脉栓塞、二次开胸探查的机率无统计学差异(P > 0.05)。达芬奇组及常规组患者术后1个月复查LVEF差异无统计学差异(P = 0.433)，且两组症状较术前均有改善。达芬奇组总住院费用较常规组明显增多(P < 0.001)。结论：达芬奇机器人辅助二尖瓣置换术在手术安全性、可行性上与常规开胸二尖瓣置换术相当，且并不增加术后并发症的发生；此外达芬奇机器人辅助二尖瓣置换术在术后恢复上显著优于常规开胸二尖瓣置换术，但其较长的手术时间、体外循环时间和主动脉阻断时间以及更高的住院费用也值得未来继续改进。
Objective: By comparing the clinical treatment effect of patients under the assistance of Da Vinci robot and conventional thoracotomy mitral valve replacement surgery, the advantages and disad-vantages of Da Vinci robot surgery system in mitral valve replacement surgery are further clarified, providing certain data support and improvement direction for its application in cardiac surgery. Methods: 282 patients with mitral valve replacement surgery performed by the affiliated hospital of Qingdao University from January 2018 to January 2022 were collected, including 70 patients with mitral valve replacement surgery assisted by Da Vinci robot, named Da Vinci group; 212 patients with conventional open mitral valve replacement were named as the conventional group. We collect the basic preoperative information, intraoperative data, the incidence of postoperative complica-tions, hospitalization costs, and the improvement of symptoms of the two groups of patients, which are divided into improvement, no improvement, and aggravation. SPSS software and statistical methods were used to analyze whether the above data of the two groups were different, and whether the difference was statistically significant (P value was greater than or less than 0.05). Re-sults: The patients in the Da Vinci group and the conventional group successfully completed the op-eration without hospital death, and were discharged after rehabilitation. There was no statistical difference in preoperative baseline characteristics between the da Vinci group (70 cases) and the conventional group (212 cases) (P > 0.05). The operation time, cardiopulmonary bypass time and aortic occlusion time of patients in the da Vinci group were significantly longer than those in the conventional group (P < 0.001). The