机器人手术与传统胸骨切开术切除心脏黏液瘤的比较结果：一项荟萃分析。

Comparative outcomes of robotic surgery conventional sternotomy for cardiac myxoma excision: A meta-analysis.

作者信息

Khawar Mirza Muhammad Hadeed, Ejaz Hooria, Jaffar Muhammad Soban, Kashif Muhammad, Habib Mavia, Mukhtar Absar, Riaz Hafsa, Shah Syed Abdullah, Muhammad Awon, Ali Umad, Saeed Hannan, Buhadur Ali Muhammad Khan, Chhetri Rejina

机构信息

Department of Cardiology, Services Institute of Medical Sciences, Lahore 40050, Punjab, Pakistan.

Department of Cardiology, King Edward Medical University, Lahore 54000, Punjab, Pakistan.

出版信息

World J Cardiol. 2025 Aug 26;17(8):111159. doi: 10.4330/wjc.v17.i8.111159.

DOI:10.4330/wjc.v17.i8.111159

PMID:40949929

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12427083/

Abstract

BACKGROUND

Cardiac myxoma, a benign intracardiac tumor, is traditionally excised via conventional sternotomy, which is invasive and associated with longer recovery times. Minimally invasive robotic surgery has emerged as a potential alternative, offering reduced trauma and faster recovery. This meta-analysis compares the efficacy and safety of robotic surgery conventional sternotomy for cardiac myxoma excision. We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery, such as shorter hospital stays and reduced transfusion rates, despite potentially longer operative times.

AIM

To assess robotic surgery sternotomy for cardiac myxoma regarding operative times, hospital stay, transfusions, and complications.

METHODS

A systematic review was performed using EMBASE, OVID, Scopus, PubMed, Cochrane, and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision. Continuous outcomes were analyzed using mean differences (MDs), and categorical outcomes with odds ratios (ORs) and 95% confidence intervals (95%CIs). A random-effects model was used to pool data, accounting for study heterogeneity.

RESULTS

Six studies involving 425 patients (180 robotic, 245 conventional) were included. Robotic surgery significantly increased cross-clamp time (MD = 12.03 minutes, 95%CI: 2.14-21.92, = 0.02) and cardiopulmonary bypass time (MD = 28.37 minutes, 95%CI: 11.85-44.89, = 0.001). It reduced hospital stay (MD = -1.86 days, 95%CI: -2.45 to -1.27, < 0.00001) and blood transfusion requirements (OR = 0.30, 95%CI: 0.13-0.69, = 0.007). No significant differences were observed in atrial arrhythmia (OR = 0.55, 95%CI: 0.27-1.12) or ventilation time (MD = -1.72 hours, 95%CI: -5.27 to 1.83, = 0.34).

CONCLUSION

Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs, suggesting enhanced recovery without compromising safety.

摘要

背景

心脏黏液瘤是一种良性心脏肿瘤，传统上通过常规胸骨切开术切除，这种手术具有侵入性且恢复时间较长。微创机器人手术已成为一种潜在的替代方法，具有创伤小、恢复快的特点。本荟萃分析比较了机器人手术与传统胸骨切开术切除心脏黏液瘤的疗效和安全性。我们假设，尽管手术时间可能较长，但机器人手术将提供相当的安全结果，并改善术后恢复，如缩短住院时间和降低输血率。

目的

评估机器人手术与胸骨切开术治疗心脏黏液瘤的手术时间、住院时间、输血情况及并发症。

方法

使用EMBASE、OVID、Scopus、PubMed、Cochrane和ScienceDirect数据库进行系统评价，以识别比较机器人手术和胸骨切开术切除心脏黏液瘤的研究。连续变量结果采用平均差（MD）分析，分类变量结果采用比值比（OR）和95%置信区间（95%CI）分析。采用随机效应模型汇总数据，考虑研究的异质性。

结果

纳入6项研究，共425例患者（180例机器人手术，245例传统手术）。机器人手术显著增加了主动脉阻断时间（MD = 12.03分钟，95%CI：2.14 - 21.92，P = 0.02）和体外循环时间（MD = 28.37分钟，95%CI：11.85 - 44.89，P = 0.001）。它缩短了住院时间（MD = -1.86天，95%CI： - 2.45至 - 1.27，P < 0.00001）和输血需求（OR = 0.30，95%CI：0.13 - 0.69，P = 0.007）。在房性心律失常（OR = 0.55，95%CI：0.27 - 1.12）或通气时间（MD = -1.72小时，95%CI： - 5.27至1.83，P = 0.34）方面未观察到显著差异。