完全胸腔镜与正中开胸对二尖瓣置换术疗效的Meta分析  

Efficacy of totally thorascopic and median sternotomy approaches for mitral valve replacement： A meta analysis

作　　者：艾力·艾比不拉 阿布都外里·热合曼 木拉提·阿不都热合曼[1] 阿布都乃比·麦麦提艾力[1] 

机构地区：[1]新疆医科大学第一附属医院心脏外科,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国心血管病研究》2017年第10期937-941,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的系统评价完全胸腔镜与正中开胸对二尖瓣置换术疗效的有效性和安全性。方法计算机检索The Cochrane Library（2016第5期）、PubMed、EMbase、CBM、CNKI、WanFangData和VIP数据库，搜集有关完全胸腔镜与正中开胸二尖瓣置换术疗效的随机对照试验（RCT）和队列研究，检索时限均从建库至2016年10月。由2位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后，采用RevMan5．2软件进行Meta分析。结果最终纳入了6个队列研究，总共608例患者，其中完全胸腔镜组（试验组）270例、正中开胸组（对照组）338例。Meta分析结果显示，完全胸腔镜组术后呼吸机辅助时间（MD=-1．82，95％ CI-3．38～0．26，P=0．02）、住院天数（MD=-3．50，95％CI—6．04--0．95，P=0．007）明显短于开胸组，术后引流量（MD=-99．40，95％CI-181．30--17．50，P=0．02）明显少于开胸组，但其主动脉阻断时间（MD=16．05，95％CI2．47～29．62，P=0．02）明显长于开胸组。结论完全胸腔镜下二尖瓣置换术与传统开胸正中切口二尖瓣置换术相比，可明显减少术后引流量，缩短术后呼吸机辅助时间和住院天数，但有延长主动脉阻断时间的风险。Objective To systematically review the efficacy of totally thorascopic and median sternotomy approaches for mitral valve replacement （MVR）. Methods Databases including the Coehrane Library （Issue5, 2016）, PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from their inception to October 2016. All RCT and cohort studies about the efficacy of totally thorascopic and median sternotomy ap- proaches for MVR were analyzed. Two reviewers identified the literature independently according to inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, meta-analysis was per- formed using RevMan 5.2 software. Results Eventually 6 cohort studies were enrolled, a total of 608 cases of pa- tients, including thorascopic group（test group） 270 cases, sternotomy group（control group） 338 cases. The results of the recta-analysis showed that： Totally Thorascopic group postoperative ventilation time （MD=-1.82, 95%CI -3.38--0.26, P=0.02）, hospital stay time（MD=-3.50,95%Cl -6.04--0.95,P=0.007） were significantly shorter than in the Median Stemotomy group, postoperative drainage （MD=-99.40,95%CI - 181.30-- 17.50, P=0.02 ） were also less than in the Median Sternotomy group, but the aortic clamping time （MD=16.05,95%CI 2.47-29.62,P= 0.02） was significantly longer than that in the Median Sternotomy group. Conclusion Compared with the Median Sternotomy group totally thorascopic group significantly reduces postoperative ventilation time, hospital stay time and postoperative drainage, but there is the risk of prolonged aortic cross-clamping time. Due to the quantity and quality of the included studies, the above conclusions still needs to be verified by carrying out more studies.

关 键 词：二尖瓣置换术 完全胸腔镜手术 微创手术 心脏手术 

分 类 号：R654.2[医药卫生—外科学]