机器人辅助与传统心脏搭桥手术的 Meta 分析

摘要/Abstract

目的：目前，冠脉搭桥手术仍以传统正中开胸为主，但各种微创手术正在快速发展。机器人辅助的冠脉搭桥手术已逐渐开展，但其应用仍然存在争议，且缺乏高质量的证据。本研究应用 Meta 分析比较现有文献中使用达芬奇机器人的冠脉搭桥与非机器人冠脉搭桥手术的差异。方法：检索 PubMed 和 The Cochrane Library 数据库，收集相关临床研究，检索时限为建库至 2021 年 7 月。由 2 名研究者独立筛选文献、提取资料，并对纳入的文献进行偏倚风险评估。采用 RevMan 5.3 软件进行 Meta 分析。结果：纳入 16 项临床研究，共 1 467 198 例患者，其中机器人心脏搭桥（Robot-assisted coronary artery bypass，RCAB）组 20 879 例，非机器人搭桥（Non-RCAB）组 1 446 319 例。两组患者术前各项指标未见显著差异。RCAB 组患者的术后并发症（卒中、感染、肾衰竭、输血、院内死亡）发生率显著低于 Non-RCAB 组，机械通气时间、ICU 停留时间和住院时间较 Non-RCAB 组短，手术时间短于 Non-RCAB 组，但差异无统计学意义。结论：Meta 分析结果显示，RCAB 手术比 Non-RCAB 在术后并发症、机械通气时间、ICU 停留时间和住院时间方面具有优势，但其他围术期指标以及短期和长期预后还需要高质量的临床对照研究。

Objective: To systematically evaluate and compare the safety and efficacy of robot-assisted coronary artery bypass surgery (RCAB) and Non-RCAB. Methods: A systematic review of primary studies on English literatures following Cochrane Collaboration guidelines was performed. Structured search strategies were developed and applied to the PubMed, Cochrane library, EMBASE, and Web of Science databases. The included literatures were processed with RevMan 5.3 software for meta-analysis after risk of bias assessment. Results: A total of 16 studies involving 1 467 198 patients were included, including 20 879 cases of RCAB and 1 467 198 cases of Non-RCAB. The overall quality of the evidence was low. Among the comparable parameters, RCAB patients had lower rate of postoperative complication, shorter ventilation time, ICU time and hospital stay, even no significant differences were found. Conclusion: RCAB is superior to Non-RCAB on postoperative complication, ventilation time, ICU time and hospital stay. However, high quality case-control studies shall be performed for further assessment on short-term and long-term prognosis and other perioperative indicators.

稿件信息

参考文献

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