机器人辅助与正中开胸在心脏外科手术中疗效对比的系统评价与Meta分析

Systematic review and Meta-analysis on efficacy of robotic cardiac surgery versus median sternotomy

目的:系统性评价并对比机器人(Robotic system,RS)组与正中开胸(Median sternotomy,MS)组在心脏外科手术中的安全性及有效性。方法:计算机检索知网、维普、万方、中国生物医学文献、Embase、PubMed及Cochrane Library数据库。筛选建库至2021年关于机器人与正中开胸在心脏外科效果方面对比的相关研究。结果:共纳入22个研究,4875例患者,其中机器人组2372例,正中开胸组2503例。共14个结局指标进入Meta分析,其中11个指标合并结果具有统计学意义,包括CPB时间(P<0.01)、升主动脉阻断时间(P<0.01)、机械通气时间(P<0.01)、ICU停留时间(P=0.007)、术后住院时间(P<0.01)、胸腔引流量(P<0.01),并发症发生率(P<0.01)、术中输血(P<0.01)、切口满意(P<0.01)、生理评分(P<0.01)、心理评分(P=0.008)。结论:心脏外科机器人系统较正中开胸手术治疗效果更佳。

Objective:To systematically evaluate and compare the safety and efficacy of robotic system(RS)and median sternotomy(MS)in cardiac surgery.Methods:CNKI,VIP,Wanfang Data,CBMdisc,Embase,PubMed and Cochrane library were searched.The database on clinical effects of robotic system versus median sternotomy in cardiac surgery by the end of 2021 was established.Results:A total of 22 studies involving 4875 patients were included,2372 patients were divided into robotic group and 2503 patients into traditional thoracotomy group.14 outcome indicators were analyzed by Meta-analysis,and results of 11 indexes were statistically significant,including CPB time(P<0.01),ascending aorta occlusion time(P<0.01),mechanical ventilation time(P<0.01),ICU stay time(P=0.007),postoperative hospital stay(P<0.01),thoracic drainage volume(P<0.01),complication rate(P<0.01),intraoperative blood transfusion(P<0.01),incision satisfaction(P<0.01),physiological score(P<0.01),psychological score(P=0.008),Conclusion:The clinical effect of robotic surgical system is better than that of median sternotomy in cardiac surgery.