Saad Rasheed A, Badr Adel, Goodwin Andrew T, Dunning Joel
Department of Cardio-thoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
Interact Cardiovasc Thorac Surg. 2009 Oct;9(4):698-702. doi: 10.1510/icvts.2009.216317. Epub 2009 Jul 28.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was which side of the operating table you should stand on when carrying out surgical revascularization on a patient with dextrocardia. Altogether 40 papers were found using the reported search, of which 19 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers are tabulated. The side on which the operating surgeon stood was mentioned in 20 out of the 24 cases. Surgery was carried out from the conventional right side of the patient in 5 cases, while in 10 cases, it was carried out from the left side. The surgeon needed to switch sides to facilitate surgery in three cases. In addition, the right internal mammary artery (RIMA) was anastomosed to the left anterior descending artery (LAD) in 16 cases. Of these, surgery was carried out from the left side in 11 cases. The left internal mammary artery (LIMA) to LAD anastomosis was carried out in two cases, one of which was a free LIMA graft. In six cases, only vein grafts were used. Fourteen cases were carried out using cardiopulmonary bypass while 10 cases were carried out as off-pump cases with one conversion. The majority of patients were operated on from the left of the table. More cases were performed with the RIMA as the conduit of choice to the LAD.
一篇心脏外科的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是，在为右位心患者进行外科血运重建时，手术医生应站在手术台的哪一侧。通过报告的检索共找到40篇论文，其中19篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期、国家、研究的患者组、研究类型、相关结果及结果以表格形式列出。24例中有20例提到了手术医生所站的一侧。5例手术是从患者常规右侧进行的，而10例是从左侧进行的。3例中外科医生需要变换位置以利于手术操作。此外，16例中右乳内动脉（RIMA）与左前降支动脉（LAD）进行了吻合。其中，11例手术是从左侧进行的。2例进行了左乳内动脉（LIMA）与LAD的吻合，其中1例是游离LIMA移植。6例仅使用了静脉移植物。14例手术使用了体外循环，10例是不停跳手术，其中1例中转。大多数患者的手术是从手术台左侧进行的。更多病例选择使用RIMA作为通向LAD的血管 conduit 。 （注：“conduit”此处结合语境推测为“血管通道”之类意思，但原文表述稍显模糊）
