机器人辅助全内窥镜冠状动脉旁路移植术的系统评价。
Systematic review of robotic-assisted, totally endoscopic coronary artery bypass grafting.
机构信息
Sydney Medical School, The University of Sydney, Sydney, Australia; ; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia;
出版信息
Ann Cardiothorac Surg. 2013 Jul;2(4):408-18. doi: 10.3978/j.issn.2225-319X.2013.07.23.
BACKGROUND
Advancements in surgical robotic technology over the last two decades have enabled coronary artery bypass grafting to be performed totally endoscopically, and have the potential to significantly change clinical practice in the future.
METHODS
A systematic review of studies reporting clinical outcomes of total endoscopic coronary artery bypass grafting (TECABG) was performed.
RESULTS
14 appraised studies included 880 beating heart TECABGs, 360 arrested heart TECABGs, 633 one-vessel operations and 357 two-vessel operations. Patients were generally low-risk. There was a significant learning curve. The weighted means for short-term beating heart and arrested heart TECABG results respectively were: intraoperative exclusion rate of 5.7% and 1.9%, intraoperative conversion rate of 5.6% and 15.0%, all-cause mortality of 1.2% and 0.4%, stroke of 0.7% and 0.8%, myocardial infarction of 0.8% and 1.8%, new onset atrial fibrillation of 10.7% and 5.1% and post-operative reintervention rate of 2.6% and 2.3%. The overall rate of short term postoperative graft patency for beating heart and arrested heart TECABG was 98.3% and 96.4% respectively.
CONCLUSIONS
Appropriate patient selection was important in minimizing the risk of intraoperative and postoperative complications. Short-term outcomes of both beating and arrested heart TECABG were acceptable, but results so far have been heterogeneous. There were fewer studies reporting intermediate to long-term outcomes, but results were encouraging, and further investigation and development of the procedure is warranted.
背景
过去二十年来，外科机器人技术的进步使得全内窥镜冠状动脉旁路移植术得以实现，并有可能在未来显著改变临床实践。
方法
对报道全内窥镜冠状动脉旁路移植术（TECABG）临床结果的研究进行了系统评价。
结果
14 项评估研究纳入了 880 例心脏不停跳 TECABG、360 例心脏停跳 TECABG、633 例单支血管手术和 357 例双支血管手术。患者一般为低危人群。存在明显的学习曲线。短期心脏不停跳和心脏停跳 TECABG 的加权平均值分别为：术中排除率 5.7%和 1.9%，术中转化率 5.6%和 15.0%，全因死亡率 1.2%和 0.4%，卒中率 0.7%和 0.8%，心肌梗死率 0.8%和 1.8%，新发心房颤动率 10.7%和 5.1%，术后再次介入治疗率 2.6%和 2.3%。心脏不停跳和心脏停跳 TECABG 的术后短期桥血管通畅率分别为 98.3%和 96.4%。
结论
适当的患者选择对于降低术中及术后并发症的风险至关重要。心脏不停跳和心脏停跳 TECABG 的短期结果均可以接受，但目前的结果尚存在异质性。有较少的研究报告了中期至长期结果，但结果令人鼓舞，进一步的研究和该手术的发展是必要的。
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