机器人与经胸骨正中切开入路行房间隔缺损修补术的疗效对比

Robotic versus sternotomy approach for closure of atrial septal defect

目的比较机器人(da Vinci Si)辅助与经胸骨正中切开入路行房间隔缺损(atrial septal defect,ASD)修补术的短期疗效。方法回顾性分析2016年1月至2020年5月于安徽医科大学第一附属医院心脏大血管外科接受ASD修补术140例患者的临床资料。根据手术方式将所有患者分为机器人组和正中开胸组,其中机器人组67例,男20例、女47例,中位年龄40.0(25.0)岁;正中开胸组73例,男23例、女50例,中位年龄41.0(29.0)岁。使用多元线性回归对相关临床特征进行校正分析。随访两组患者术后恢复日常锻炼的时间,使用Kaplan-Meier法绘制生存曲线。结果与正中开胸组相比,机器人手术具有更少的术后24 h引流量[220.0(210.0)mL vs.345.0(265.0)mL,P<0.001]、更短的机械通气时间[6.0(11.0)h vs.8.0(11.0)h,P=0.024]、ICU住院时间[19.0(19.0)h vs.22.0(25.0)h,P=0.005]、术后总住院时间[9.0(5.0)d vs.10.0(6.0)d,P=0.003]和更低的围术期输血率(28.36%vs.84.93%,P<0.001)。使用多元线性回归进行校正后的统计分析结果表明,机器人手术仍有术后24 h引流量低(β=–115.30,95%CI–170.78~–59.82,P<0.001)、机械通气时间缩短(β=–4.96,95%CI–8.33~–1.59,P=0.004)和术后总住院时间缩短(β=–2.31,95%CI–3.98~–0.63,P=0.007)的趋势。Kaplan-Meier生存分析结果表明,机器人组术后恢复日常锻炼的时间明显短于正中开胸组[35.0(32.0)d vs.90.0(75.0)d,P<0.001]。结论机器人系统辅助技术可安全有效地应用于ASD修补术,其手术微创,临床效果满意,利于术后加速康复。

Objective To compare the short-term outcomes of surgical repair for atrial septal defect(ASD)with a robotic(da Vinci Si)approach versus a conventional open procedure.Methods Clinical data of 140 patients undergoing ASD closure in the First Affiliated Hospital of Anhui Medical University from January 2016 to May 2020 were retrospectively analyzed.The patients were divided into a robotic group and a sternotomy group according to different surgical methods.In the robotic group,there were 67 patients including 20 males and 47 females at a median age of 40.0(25.0)years,and in the sternotomy group there were 73 patients including 23 males and 50 females at a median age of 41.0(29.0)years.Multivariate linear regressions were used to produce risk-adjusted analysis of pertinent clinical characteristics.Kaplan-Meier analysis was performed to compare the speed of sternotomy versus robotic group returning to exercise or daily life.Results Robotic-assisted surgery was associated with significantly shorter 24 h postoperative drainage volume[220.0(210.0)mL vs.345.0(265.0)mL,P<0.001],mechanical ventilation[6.0(11.0)h vs.8.0(11.0)h,P=0.024],intensive care unit length of stay(LOS)[19.0(19.0)h vs.22.0(25.0)h,P=0.005],postoperative hospital LOS[9.0(5.0)d vs.10.0(6.0)d,P=0.003],and a lower rate of perioperative blood transfusion(28.36%vs.84.93%,P<0.001).After controlling for patient comorbidity in the multiple regression model,there remained a trend toward decreased 24 h postoperative drainage volume(β=–115.30,95%CI–170.78 to–59.82,P<0.001),mechanical ventilation(β=–4.96,95%CI–8.33 to–1.59,P=0.004)and postoperative hospital LOS(β=–2.31,95%CI–3.98 to–0.63,P=0.007)in the robotic group.Kaplan-Meier analysis revealed that patients returned to exercise or daily life earlier in the robotic group[35.0(32.0)d vs.90.0(75.0)d,P<0.001].Conclusion Closure of ASD can be performed safely and effectively via robotic approach.And the minimally invasive technique is beneficial to postoperative recovery.