微创心脏外科手术与传统开胸心脏手术术后疗效的系统评价  

Cardiac Surgery Via Minimally Invasive Incision versus Median Sternotomy:A Systematic Review

作　　者：殷亮[1] 王志农[1] 王毅峰[1] 王文涛[1] 纪广玉[1] 杨新伟[1] 徐志云[1] 

机构地区：[1]第二军医大学附属长海医院胸心外科,上海200433

出　　处：《中国循证医学杂志》2009年第8期849-854,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价微创心脏外科手术与传统开胸手术的术后疗效。方法计算机检索CBM、VIP、CNKI、PubMed和Elsevier数据库,纳入1995～2008年间国内外关于微创心脏外科手术与传统开胸手术术后疗效分析的临床研究,并采用RevMan4.2软件进行Meta分析。结果共纳入8个研究,包括2个随机对照试验和6个队列研究,共1204例患者,其中微创手术组492例,传统开胸手术组712例。Meta分析结果显示:微创手术组在体外循环时间[WMD=16.45,95%CI(2.56,30.35),P=0.02]、胸腔闭式引流量[WMD=-132.63,95%CI(-208.53,-56.72),P=0.0006]和住院时间[WMD=-1.22,95%CI(-2.14,-0.30),P=0.009]上都明显低于传统开胸手术组,但主动脉阻断时间[WMD=0.47,95%CI(-1.35,2.29),P=0.61]和手术时间[WMD=26.67,95%CI(-8.91,62.25),P=0.14]两组差异无统计学意义。结论微创心脏外科手术相比传统手术疗效更好,具有独特的优越性,值得推广。Objective To evaluate whether minimally invasive （MI） cardiac surgery has advantages over conventional median sternotomy （MS）, so as to provide evidence for clinical diagnosis and therapy. Methods We searched CBM, VIP, CNKI, PubMed, and Elsevier databases from 1995 through 2008. The literature about the therapeutic effect of minimally invasive cardiac surgery and conventional median sternotomy was identified. The data was extracted, and the methodological quality was evaluated by two reviewers independently. The Meta-analyses were performed using RevMan 4.2 software. Results A total of 8 studies involving 492 MI patients and 712 MS patients met the inclusion criteria. Of these eight studies, two studies were randomized trials and the other six studies were retrospective cohort studies. The results of meta-analyses showed that the MI group had a better postoperative effect, and the cardiopulmonary bypass time （WMD=-16.45, 95%CI 2.56 to 30.35, P=0.02）, chest-tube drainage （WMD= -132.63, 95%CI -208.53 to -56.72, P=0.0006） and hospitalization stay （WMD= -1.22, 95%CI -2.14 to -0.30, P=0.009） of MI group were less than those of MS group, but the aorta clamping time （WMD=0.47, 95%CI -1.35 to 2.29, P=0.61） and operating time （WMD=26.67, 95%CI -8.91 to 62.25, P=0.14） were not significantly different between the two groups. Conclusion The minimally invasive cardiac surgery has a better postoperative therapeutic effect than conventional median sternotomy cardiac surgery.

关 键 词：微创 开胸 心脏外科 疗效 Meta分析 

分 类 号：R654.2[医药卫生—外科学] R681.53[医药卫生—临床医学]