冠状动脉旁路移植术中稳定器的应用和发展

Application and development of stabilizers in coronary artery bypass grafting

二十多年前,首例机器人心脏手术就已经开展了。近年来,侵入性更小的心脏外科技术越来越受欢迎。而各种新兴材料、计算机和工程技术的整合发展为机器人手术应用于各类心脏术式提供了条件。目前开展较多的术式包括冠状动脉旁路移植、二尖瓣成形/换瓣和心房纤颤的射频/冷冻消融等。目前,只有少数国际性心脏中心的团队专攻全内窥镜下冠状动脉旁路移植术。尽管一些研究表明,机器人辅助心脏手术取得了良好效果,但学界仍然对其安全性、成本/效益比以及临床远期疗效存在疑问。机器人心脏手术对心肌保护与精准吻合技术提出了更高的挑战。稳定器的作用是给心脏手术提供相对稳定的视野,这是一切不停跳的心脏外科手术的基础,正是因为稳定器具有非常重要的意义,所以全世界的研发人员都在不断探索如何开发出新型的更精密的稳定器。本综述围绕稳定器的研发应用现状和发展趋势,总结当前常用稳定器的优缺点,紧贴临床,深入分析,提出了冠状动脉搭桥手术中稳定器的未来发展要点。

The first robotic heart surgery was performed more than two decades ago.Less invasive cardiac surgical techniques have become increasingly popular in recent years.The integration of emerging materials,computers and engineering technologies has provided the conditions for the application of robotic surgery in various cardiac procedures.Coronary artery bypass grafting(CABG),mitral valvuloplasty/valvuloplasty and radiofrequency/cryoablation for atrial fibrillation are some of the most common surgical procedures.Currently,only a few international cardiac centers have teams specializing in total endoscopic coronary artery bypass grafting.Although some studies have shown good results in robot-assisted heart surgery,questions remain about its safety,cost-benefit ratio,and long-term clinical outcomes.Robotic heart surgery poses higher challenges to myocardial protection and precise anastomosis.The role of stabilizers is to provide a relatively stable field of vision for heart surgery,which is the basis of all non-stop heart surgery.Because of their importance,researchers around the world are constantly exploring how to develop new,more sophisticated stabilizers.This review focuses on the research and development status and development trend of the stabilizer,summarizes the advantages and disadvantages of the current commonly used stabilizer,closely follows the clinic,makes in-depth analysis,and puts forward the key points of the future development of the stabilizer in coronary artery bypass surgery.