内镜微创与正中开胸手术治疗心房粘液瘤临床疗效的系统评价与Meta分析  

Clinical efficacy of endoscopic minimally invasive versus median sternotomy thoracotomy for atrial myxoma:A systematic review and meta-analysis

作　　者：张旭[1] 伊凡 霍强[1] 艾斯卡尔·沙比提[1] ZHANG Xu;YI Fan;HUO Qiang;AI SiKaEr ShaBiTi(Department of Cardiac Surgery Division One,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,830054,P.R.China;Department of Gastroenterology,Urumqi Traditional Chinese Medicine Hospital,Urumqi,830000,P.R.China)

机构地区：[1]新疆医科大学第一附属医院心脏外科一科,乌鲁木齐830054 [2]乌鲁木齐市中医医院脾胃病科,乌鲁木齐83000

出　　处：《中国胸心血管外科临床杂志》2022年第9期1189-1196,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的运用Meta分析的方法对比内镜微创手术与正中开胸手术治疗心房粘液瘤的临床疗效。方法计算机检索中国生物医学、知网、万方、维普、PubMed、the Cochrane Library、EMbase,搜集有关心房粘液瘤与内镜微创手术的相关研究,检索时限为建库至2020年9月,由2位评价员独立筛选文献、提取资料,运用纽卡斯尔-渥太华量表评估偏倚风险后,应用Stata 16.0进行Meta分析。结果纳入10篇病例对照研究,其中质量等级为A级5篇,B级5篇;样本量为938例,内镜微创组480例,正中开胸组458例,随访595例。共纳入18个结局指标,两组9个结局指标的合并结果差异具有统计学意义:体外循环时间[SMD=0.32,95%CI(0.00,0.63),P=0.048];呼吸机辅助通气时间[SMD=–0.35,95%CI(–0.56,–0.15),P=0.001];ICU停留时间[SMD=–0.42,95%CI(–0.62,–0.21),P<0.001];术后住院时间[SMD=–0.91,95%CI(–1.22,–0.60),P<0.001];术后引流量[SMD=–2.48,95%CI(–5.24,0.28),P<0.001];术后新发房颤[OR=0.29,95%CI(0.12,0.67),P=0.005];术后肺炎[OR=0.09,95%CI(0.02,0.36),P=0.001];术后输血[OR=0.22,95%CI(0.11,0.45),P<0.001];切口满意[OR=83.15,95%CI(1.24,5563.29),P=0.039]。结论现有证据表明正中开胸手术较内镜微创手术的体外循环时间更短;术后在院和5年随访中ICU停留时间、术后住院时间、术后引流量、术后新发房颤、术后肺炎、术后输血、切口满意,内镜微创手术较正中开胸手术有更好的结果。Objective To compare the clinical efficacy of endoscopic minimally invasive surgery and median sternotomy thoracotomy in the treatment of atrial myxoma by meta-analysis.Methods We searched CBM,CNKI,Wanfang Data,VIP,PubMed,the Cochrane Library and EMbase to collect relevant researches on atrial myxoma and endoscopic minimally invasive surgery.The retrieval time was from the establishment of the database to September 2020.Two reviewers independently screened the literature,extracted data and evaluated the bias risk of included studies by the Newcastle-Ottawa scale(NOS).Then,the meta-analysis was performed by Stata 16.0.Results Ten articles were included in the study,all of which were case-control studies.The quality of literature was grade B in 5 articles and grade A in 5 articles.The sample size of surgery was 938 patients,including 480 patients in the endoscopic minimally invasive group,458 patients in the median thoracotomy group,and 595 patients in follow-up.A total of 18 outcome indexes were included in the meta-analysis.The combined results of 9 outcome indicators were statistically significant:cardiopulmonary bypass time(SMD=0.32,95%CI 0.00 to 0.63,P=0.048);ventilator assisted ventilation time(SMD=-0.35,95%CI-0.56 to-0.15,P=0.001),ICU stay time(SMD=–0.42,95%CI-0.62 to-0.21,P<0.001);postoperative hospitalization time(SMD=-0.91,95%CI-1.22 to-0.60,P<0.001);postoperative drainage volume(SMD=-2.48,95%CI-5.24 to 0.28,P<0.001);postoperative new onset atrial fibrillation(OR=0.29,95%CI 0.12 to 0.67,P=0.005);postoperative pneumonia(OR=0.09,95%CI 0.02 to 0.36,P=0.001);postoperative blood transfusion(OR=0.22,95%CI 0.11 to 0.45,P<0.001);incision satisfaction(OR=83.15,95%CI 1.24 to 5563.29,P=0.039).Conclusion Available evidence suggests that median thoracotomy requires shorter cardiopulmonary bypass time than endoscopic minimally invasive surgery;during the 5-year follow-up after surgery and discharge,ICU stay time,postoperative hospital stay,postoperative drainage,new atrial fibrillation after surgery,postoperative pne

关 键 词：心房粘液瘤 胸腔镜 机器人 微创手术 系统评价/META分析 

分 类 号：R732.1[医药卫生—肿瘤]