机器人手术与传统开胸手术在心脏肿瘤患者治疗中的对比:倾向评分匹配分析  

Robotic surgery versus conventional open chest surgery for heart tumor:a propensity score matching analysis

作　　者：李双磊[1] 高长青[1] 

机构地区：[1]中国人民解放军总医院心血管外科,北京100853

出　　处：《南方医科大学学报》2017年第10期1296-1300,共5页Journal of Southern Medical University

基　　金：国家高技术研究发展计划(863计划)(2012AA021104)~~

摘　　要：目的分析对比心脏肿瘤患者行传统开胸手术与机器人手术的疗效、短期预后及患者选择。方法采集1993年1月~2016年4月在我院行心脏肿瘤切除手术的225名患者(153名患者接受传统手术,60名患者接受机器人手术,12名患者接受右前外侧小切口手术)信息,对行机器人手术及传统开胸手术的心脏肿瘤患者进行筛选并根据重点基线数据进行倾向评分匹配(PSM),分析两组的疗效、短期预后及患者选择。结果筛选后,PSM前传统手术组(125例)较机器人手术组(60例),肿瘤尺寸更大(P<0.001),心功能Ⅲ级或Ⅳ级患者比例更高(P<0.001)。匹配后,两组患者基线数据上基本平衡(P=0.982)。两组患者(各60例)在体外循环时间、主动脉阻断时间、院内死亡率、术后并发心律失常、延迟通气、胸部并发症及系统栓塞方面无显著差异(P均>0.05)。两组患者术后6个月内生存率均为100%,且主要血管和脑血管风险事件发生率无显著差异(P=0.438)。结论机器人心脏肿瘤切除术具有良好的疗效且短期预后良好,对于首次、单发、低危的心脏肿瘤患者可作为选择性术式。Objective To compare conventional open chest surgery and robotic surgery for their efficacy,short-term outcomes and patient selection in the treatment of heart tumors.Method The clinical data were collected from 225 patients（a total of 228 operations） who underwent cardiac neoplasm resection in our hospital between January,1993 and April,2016.A propensity score matching（PSM） was established according to the vital baseline data of the patients receiving conventional open chest surgery（n=125） and robotic surgery（n=60） after screening.The patients were matched for propensity into 60 pairs,and the efficacy,short-term outcomes and patient selection were compared between the two groups.Results Before PSM,the patients in conventional surgery group had significantly greater tumor size（P〈0.001） and a higher proportion of patients with New York Heart Association functional class III and IV（P〈0.001）.The patients＇ baseline data were nearly balanced（P=0.982）between the two groups after matching.No significant differences were found between the two groups in cardiopulmonary bypass time（P=0.256）,crossclamp time（P=0.862）,in-hospital mortality（P=1.000）,arrhythmia（P=1.000）,delayed mechanical ventilation（〉24 h;P=0.209）,thoracic complications（P=0.611） or systemic embolism（P=1.000）.The survival rates were 100% in both groups in the 6-month follow-up after the operation,and no significant difference was found between the two groups in the incidence of major adverse cardiac and cerebrovascular events within 6 months（P=0.438）.Conclusion Robotic heart tumor resection has a favorable efficacy with a good short-term prognosis,and can serve as an alternative for treatment of solitary lesions in low-risk patients receiving operations for the first time.

关 键 词：心脏肿瘤 机器人手术 倾向评分匹配 

分 类 号：R732.1[医药卫生—肿瘤]