机器人辅助肺移植：微创移植手术早期结局的系统评价。
完整摘要 · 中文译文
肺移植传统上通过蚌壳式胸骨横断切开术或胸骨切开术进行，这些入路与疼痛、伤口愈合受损和慢性神经痛相关。机器人辅助直到最近才应用于移植领域。我们系统回顾了机器人辅助肺移植的临床经验。遵循PRISMA 2020和PRISMA-S，我们检索了MEDLINE、Embase、Scopus、Web of Science和Cochrane CENTRAL，时间从建库至2026年8月15日，同时检索了试验注册库、会议摘要和中文来源，无语言限制。具有至少一项临床结局的人类机器人肺移植报告符合纳入条件。由于仅存在一项比较性队列研究，综合方式为叙述性；未进行荟萃分析。按结局对证据确定性进行分级。PROSPERO：CRD420261479535。在393条数据库记录和7条来自其他方法的记录中，纳入了来自五个报告中心的六篇报告（27例唯一受者）。未发现随机试验或既往完整系统评价。在唯一的比较性队列中（机器人组n=21对比直视微创组n=90），一年生存率为95.0%对比95.5%（log-rank P=0.84），72小时3级原发性移植物功能障碍为4.8%对比8.9%（比值比0.51，95% CI 0.06-4.34），尽管缺血时间更长（486对比408分钟；P=0.02）。机器人组与直视组的所有置信区间均包含1。所有结局的确定性均为极低。机器人肺移植在五个报告中心技术上可行。比较性证据仅基于一项临床选择性队列，且所有结局的确定性均为极低。 选择性、非随机化队列，其中未检测到统计学差异；这既不能确立等效性，也不能排除危害。需要采用标准化结局进行多中心前瞻性评估。注册：该方案已在PROSPERO注册（CRD420261479535）。
完整摘要 · 英文原文
Lung transplantation is conventionally performed through clamshell thoracosternotomy or sternotomy, approaches associated with pain, impaired wound healing, and chronic neuralgia. Robotic assistance has reached transplantation only recently. We systematically reviewed the clinical experience with robotic-assisted lung transplantation. Following PRISMA 2020 and PRISMA-S, we searched MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL from inception to 15 August 2026, with trial registries, conference abstracts, and Chinese-language sources, without language restriction. Human robotic lung transplant reports with at least one clinical outcome were eligible. Because only one comparative cohort existed, synthesis was narrative; no meta-analysis was performed. Certainty was graded by outcome. PROSPERO: CRD420261479535. Out of 393 database records and 7 from other methods, six reports from five reporting centers (27 unique recipients) were included. No randomized trial or prior full-length systematic review was identified. In the only comparative cohort (robotic n = 21 vs. direct-vision minimally invasive n = 90), one-year survival was 95.0% versus 95.5% (log-rank P = 0.84) and grade-3 primary graft dysfunction at 72 h 4.8% versus 8.9% (odds ratio 0.51, 95% CI 0.06-4.34), despite longer ischemic times (486 vs. 408 min; P = 0.02). Every robotic versus direct-vision confidence interval included unity. Certainty was very low for all outcomes. Robotic lung transplantation is technically feasible across five reporting centers. Comparative evidence rests on one clinically selected, non-randomized cohort in which no difference was statistically detectable; this establishes neither equivalence nor absence of harm. Multicenter prospective evaluation with standardized outcomes is required.Registration: The protocol was registered with PROSPERO (CRD420261479535).