系统综述

机器人辅助完全内窥镜下冠状动脉旁路移植术的系统评价

Published at: 2014年第1卷第8期

SecoMichael 1 , EdelmanJ. James B. 2 , YanTristan D. 3 , WilsonMichael K. 4 , BannonPaul G. 3 , VallelyMichael P. 5
1 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
2 The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
3 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; The Collaborative Research (CORE) Group, Sydney, Australia
4 The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Cardiothoracic Surgical Unit, Macquarie University Hospital, Sydney Australia
5 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; Cardiothoracic Surgical Unit, Macquarie University Hospital, Sydney Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia

摘要

背景:近二十年来,机器人手术技术的发展使得冠状动脉旁路移植术能够在完全内窥镜下操作完成,并可能在很大程度上改变未来的临床实践。 方法:系统性评价完全内窥镜下冠状动脉旁路移植术(total endoscopic coronary artery bypass grafting,TECABG)的临床研究结果。 结果:14项评价入选的研究共包括880例心脏不停跳TECABG,360例心脏停跳的TECABG,633例单支血管手术和357例双支血管手术。患者通常为低危患者。TECABG有一个明显的学习曲线。评价短期心脏不停跳和心脏停跳TECABG结果的加权平均值分别为:术中排除率为5.7%和1.9%,术中转换率为5.6%和15.0%,全因死亡率为1.2%和0.4%,中风发生率为0.7%和0.8%,心肌梗死发生率为0.8%和1.8%,新发房颤率为10.7%和5.1%,术后再干预率为2.6%和2.3%。心脏不停跳和心脏停跳TECABG的术后短期移植物总体通畅率分别为98.3%和96.4%。 结论:合理的选择病例对降低术中及术后并发症风险是很重要的。心脏不停跳和心脏停跳TECABG的术后短期结果是可以令人接受的,但是目前结果仍然具有多样性。尽管很少有中长期结果的研究报道,但其结果是令人欣慰的。因此,TECABG有待于进一步研究和技术的发展。

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