经胸封堵与传统开胸修补治疗房间隔缺损疗效比较的Meta分析  

A comparison in curative effect between transthoracic closure and traditional thoracotomy in treatment of atrial septal defect:a Meta-analysis

作　　者：移康[1,2] 王丹 尤涛[1,2] 周国磊[2,4] 许建国 马龙 张鑫 Yi Kang;Wang Dan;You Tao;Zhou Guolei;Xu Jianguo;Ma Long;Zhang Xin(Department of Cardiovascular Surgery,People's Hospital of Gansu Province,Lanzhou 730000,China.;不详)

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410008 [4]甘肃中医药大学,兰州730000 [5]兰州大学循证医学中心,兰州大学基础医学院,兰州730000

出　　处：《中国循证心血管医学杂志》2020年第12期1417-1424,共8页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：甘肃省卫生行业科研计划项目(GSWSKY2016-04)。

摘　　要：目的系统评价经胸封堵和传统开胸修补两种术式治疗房间隔缺损的安全性和有效性。方法计算机检索PubMed、Embase、Cochrane Library、VIP、Wanfang Data和CNKI数据库,查找关于经胸封堵和开胸修补治疗房间隔缺损相关研究文献,检索时限均从2000年1月~2018年11月。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价文献质量后,采用RevMan 5.3软件进行Meta分析。结果共纳入33个研究,3290例患者(包括实验组和对照组)。Meta分析结果显示:2组在手术成功率(RR=0.99,95%CI:0.98~1.00)、心律失常发生率(RR=0.58,95%CI:0.30~1.09)比较中无差异,经胸封堵与开胸修补在术后总并发症发生率(RR=0.55,95%CI:0.39~0.79)、手术时间(MD=-75.52,95%CI:-82.87^-68.17)、ICU停留时间(MD=-14.14,95%CI:-17.32^-10.96)、机械通气时间(MD=-89.58,95%CI:-107.23^-71.93)、手术切口长度(MD=-9.73,95%CI:-11.77^-7.69)、引流量(MD=-85.98,95%CI:-111.27^-60.69)、总住院时间(MD=-3.97,95%CI:-4.60^-3.33)、术后住院时间(MD=-3.76,95%CI:-4.58^-2.95)、手术花费(SMD=1.39,95%CI:0.53~2.26)等方面比较中,差异有统计学意义。结论现有证据表明,经胸封堵较开胸修补治疗房间隔缺损手术成功率相当,手术时间更短,对患者损伤较小且术后并发症发生率低,术后康复也更快,可作为微创治疗方案在临床加以推广并应用。Objective To review systematically the safety and efficacy of transthoracic closure and traditional thoracotomy in treatment of atrial septal defect(ASD).Methods The databases of PubMed,EMbase,Cochrane Library,VIP,WanFang Data and CNKI were retrieved with computer for searching the related literature about ASD treatment with transthoracic closure and traditional thoracotomy from Jan.2000 to Nov.2018.The literature was screened,data was extracted and quality was reviewed by 2 researchers independently according to inclusion and exclusion criteria,and a Meta-analysis was conducted by using RevMan5.3 software.Results There were totally 33 studies included involved 3290 patients(divided into test group and control group)The results of Meta-analysis showed that there was no difference in operative success rate(RR=0.99,95%CI:0.98~1.00)and incidence rate of arrhythmia(RR=0.58,95%CI:0.30~1.09)between test group and control group.The difference had statistical significance in total incidence rate of complications(RR=0.55,95%CI:0.39~0.79),operative duration(MD=-75.52,95%CI:-82.87^-68.17),ICU staying(MD=-14.14,95%CI:-17.32^-10.96),mechanical ventilation time(MD=-89.58,95%CI:-107.23^-71.93),operative incision length(MD=-9.73,95%CI:-11.77^-7.69),drainage volume(MD=-85.98,95%CI:-111.27^-60.69),total length of hospital stay(MD=-3.97,95%CI:-4.60^-3.33),postoperative length of hospital stay(MD=-3.76,95%CI:-4.58^-2.95),and cost(SMD=1.39,95%CI:0.53~2.26).Conclusion The existing evidences indicate that transthoracic closure has the same success rate,shorter operation time,less injury to patients,lower incidence rate of complications and faster recovery compared with traditional thoracotomy in ASD treatment,which can be popularized and applied as a minimally invasive therapy in clinic.

关 键 词：房间隔缺损 经胸封堵 外科手术 META分析 系统评价 

分 类 号：R4[医药卫生—临床医学]