摘要
Objective： Mitral valve disease tends to be treated with anterolateral minithoracotomy （ALMT） rather than median stemotomy （MS）, as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods： One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results： ALMT showed a significantly longer cardiopulmonary bypass time （P=0.001） and aortic cross-clamp time （P=0.05） compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay （P〈0.00001）. According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS （P=0.05）; however, the incidence of peri-operative mortality （P=0.62）, re-operation for bleeding （P=0.37）, neurologic events （P=0.77）, myocardial infarction （P=0.84）, gastrointestinal complications （P=0.89）, and renal insufficiency （P=0.67） were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions： Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.
研究目的:二尖瓣瓣膜病越来越趋向于应用右前外侧小切口(ALMT)替代胸骨正中切口(MS)进行手术,因为其更美观、微创。本文主要是比较分析ALMT组与MS组的手术参数及术后结果。研究方法:从1996年1月至2013年1月期间发表的英文论文中,选出1篇随机对照研究及4篇病例对照研究进行分析。重要结论:目前的临床数据显示,相比较于传统的胸骨正中切口二尖瓣手术,右前外侧小切口手术是一种安全、有效的方法,具有较好的近期和远期疗效。
