系统综述

系统回顾机器人微创二尖瓣手术

Published at: 2014年第1卷第10期

Michael Seco 1 , Christopher Cao 2 , Paul Modi 3 , Paul G. Bannon 4 , Michael K. Wilson 5 , Michael P. Vallely 6 , Kevin Phan 7 , Martin Misfeld 8 , Friedrich Mohr 8 , Tristan D. Yan 9
1 Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
3 Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
4 The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
5 Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
6 The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
7 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
8 Department of Cardiac Surgery, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
9 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia

摘要

背景:机械电子操作已经进展到辅助挑战微创二尖瓣微创手术阶段。通过提供的文献的概述进行系统性回顾,主要集中在临床结果和成本的有效性上。 方法:展开搜索2013年8月的MEDLINE Embase和Cochrane 数据库。所有原始研究除了病例报道除外,研究例数大于等于50例。 结论:根据入选标准和排除标准,27个研究入选,其中16个研究病例数超过50人,所有的研究都是在自然状态下观察,证据质量介于低到中等。病人普遍左室功能良好,无明显症状,病人年龄平均在52.6-58.4岁。术中结果的发生率:0.0-9.1%转而应用为非机器人手术,体外循环时间为106±22至188.5±53.8分钟,主动脉阻断时间为79±16至140±40分钟,短期术后意外发生率:0.0-3.0%死亡,0.0-3.2%心梗,0.0-3.0%永久卒中,1.6-15%胸腔积液,0.0-5.0%因出血导致的再次手术,0.0-0.3%感染,1.1-6%延长通气时间(>48小时)1.5-5.4%早期修复失败,12.3±6.7至36.6±24.7小时在监护病房时间,3.1±0.3vs6.3±3.9天住院时间。81.7-97.6%术后没有或者只有微量的二尖瓣反流。 结论:所有二尖瓣脱垂的亚型是可以用机械技术修复的,体外循环时间和主动脉阻断较长,新型技术,如Cor-Knot,Nitinol clips 或者缝合操作可以降低所需要的时间,术后早期总体死亡率和发病率都是低的。术后生活质量的提高和迅速恢复工作可以弥补先进设备和术中的花费。长期结果的证据依然是有限的。

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