法洛四联症根治术肺动脉瓣重建的有效性和安全性评估  

Efficacy and safety of pulmonary valve reconstruction during radical operation for tetralogy of Fallot:a systematic review and Meta-analysis

作　　者：移康[1,2] 王丹 尤涛[1,2] 许建国[4] 高洁 马龙 梁嘉琪 Yi Kang;Wang Dan;You Tao;Xu Jianguo;Gao Jie;Ma Long;Liang Jiaqi(Department of Cardiovascular Surgery,Gansu Provincial Hospital,Lanzhou 730000,China;Gansu Province International Science&Technology Cooperation Base for Congenital Heart Disease Diagnosis&Treatment,Lanzhou 730000,China;Xiangya Hospital,Central South University,Changsha 410000,China;Evidence-Based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;First Clinical Medical College,Lanzhou University,Lanzhou 730000,China;Gansu University of Chinese Medicine,Lanzhou 730000,China;Second Clinical Medical College,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院心血管外科,兰州730000 [2]先天性心脏病诊疗甘肃省国际科技合作基地,兰州730000 [3]中南大学湘雅医院,长沙410000 [4]兰州大学循证医学中心,兰州大学基础医学院,730000 [5]兰州大学第一临床医学院,730000 [6]甘肃中医药大学,兰州730000 [7]兰州大学第二临床医学院,730000

出　　处：《中华小儿外科杂志》2020年第10期867-875,共9页Chinese Journal of Pediatric Surgery

基　　金：甘肃省卫生行业科研计划项目(GSWSKY2016-04)。

摘　　要：目的评估法洛四联症根治术中肺动脉瓣重建术的有效性和安全性。方法全面检索PubMed、Cochrane Library、维普、万方和CNKI等数据库,收集法洛四联症根治术中肺动脉瓣重建的相关研究资料,检索时间范围均从建库至2019年5月,由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.3软件进行Meta分析。将肺动脉瓣叶重建术与传统跨环补片术进行对比分析,结局比较指标包括手术病死率、随访期肺动脉瓣反流率、并发症发生率、体外循环时间及主动脉阻断时间。结果共纳入7篇文献报道,包括538例患儿。通过对报道中肺动脉瓣叶重建术与传统跨环补片术相关指标进行对比分析可知,与跨环补片组比较,肺动脉瓣重建组术后1个月内肺动脉瓣反流率明显低于跨环补片组[RR=0.28,95%CI(0.11,0.72),P=0.008]。术后6个月肺动脉瓣重建组肺动脉瓣反流率为36.8%,跨环补片组肺动脉瓣反流率为100%,其中重度肺动脉瓣反流率分别为0和40.0%;术后1年肺动脉瓣重建组肺动脉瓣反流率为37.5%,跨环补片组肺动脉瓣反流率为95.8%;肺动脉瓣重建组中远期肺动脉瓣反流率也明显低于跨环补片组。两组间的手术病死率、体外循环时间、主动脉阻断时间和并发症发生率差异均无统计学意义。结论法洛四联症根治术中,推荐采用肺动脉瓣重建术解决右心室流出道狭窄的问题,可最大限度减少术后并发症,提高中远期手术疗效。Objective To evaluate the efficacy and safety of pulmonary valve reconstruction during radical operation for tetralogy of Fallot (TOF).Methods A meta-analysis was performed for the studies reporting the outcomes of children undergoing pulmonary valve reconstruction during radical operation for TOF. Five databases included Cochrane Library, PubMed, China National Knowledge Infrastructure, VIP and WanFang. A systematic search for controlled trials was performed within each database from its starting date up to May 2019.The relevant data were independently extracted by two reviewers. Surgical mortality, incidence of pulmonary regurgitation, incidence of complications, cardiopulmonary bypass time and aortic crossclamp time were employed for analyzing the procedural outcomes with software RevMan (Version 5.3).Results Seven retrospective studies were included with a total number of 538 participants. A comparison of pulmonary valve reconstruction and TAP groups revealed that the incidence of pulmonary regurgitation decreased in pulmonary valve reconstruction group within 1 month postoperatively [RR=0.28, 95%CI(0.11, 0.72), P=0.008]. At Month 6 postoperatively, the incidence of pulmonary regurgitation was 36.8% in pulmonary valve reconstruction group and 100% in transannular patch group and the incidence of severe regurgitation 0 and 40.0% respectively. Within 1 year, the incidence of regurgitation was 37.5% in pulmonary valve reconstruction group and 95.8% in transannular patch group. The incidence of middle/long-term regurgitation was significantly lower in pulmonary valve reconstruction group than that in transannular patch group. No significant difference existed in surgical mortality, incidence of complications, cardiopulmonary bypass time or aortic crossclamp time.Conclusions Based upon present researches, pulmonary valve reconstruction is recommended during radical operation for pediatric TOF to minimize postoperative complications and improve long-term surgical efficacies.

关 键 词：法洛四联症 肺动脉瓣 系统评价 META分析 

分 类 号：R726.5[医药卫生—儿科]