冠状动脉旁路移植术中内镜获取大隐静脉疗效的meta分析

A Meta-analysis for Endoscopic Vessel Harvesting in Great Saphenous Vein in Coronary Artery Bypass Grafting

目的系统评价冠状动脉旁路移植术(coronary artery bypass grafting,CABG)中应用内镜获取大隐静脉的安全性。方法计算机检索Cochrane Library(2012年第2期)、Pubmed、Medline、EMbase、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、数字化期刊数据库(万方)、中文科技期刊全文数据库(维普)等数据库,查找自建库至2013年9月,检索语种不受限制,收集有关GABG术中内镜获取大隐静脉疗效和安全性的随机对照试验,由2位评价者根据纳入、排除标准独立选择文献,评价纳入研究的方法学质量,然后采用Rev Man5.2软件进行meta分析。结果共纳入12篇RCT文献,共1510例,其中内镜组857例,切开组653例。meta分析显示:与切开组比较,内镜组术后切口感染率低(OR=0.24,95%CI:0.16~0.36,P<0.0001),术后疼痛发生率低(OR=-1.06,95%CI:-1.26^-0.86,P<0.0001),术后并发症发生率低(OR=0.28,95%CI:0.19~0.42,P<0.0001);2组住院时间(WMD=0.17,95%CI:-0.22~0.56,P=0.40)、死亡率无统计学差异(OR=0.88,95%CI:0.30~2.64,P=0.82)。结论 CABG中应用内镜采集大隐静脉能够减少创伤,明显降低术后下肢感染,术后疼痛、术后并发症及住院时间下降,尤其适用于存在高危因素的患者。

Objective To review systemically the safety of endoscopic vessel harvesting（EVH） in coronary artery bypass grafting （CABG）. Methods By searching documentations in the Cochrane Library, Pubmed, Medline,EMbase, CBM, CNKI, Wanfang database, and Weipu database, with no limits for language, a random-controlled meta-analysis was assembled for evaluating the safety of EVH of great saphenous veins in CABG. The retrieval deadline of these databases was September 2013. Two evaluators were in charge of selecting, extracting, and assessing the quality of methodology in all these articles according to extract criterion independently. The RevMan 5. 2 was used for meta-analyse. Results The whole test included 12 RCTs and 1510 patients, comprising of 857 patients with EVH and 653 patients with traditional harvesting. As compared with traditional group, the EVH group showed lower rate of postoperative incision infection [ OR = 0.24, 95% CI：O. 16 - 0.36, P 〈 O. 0001 ] , less postoperative pain [ OR = - 1.06, 95% CI： - 1.26 - - O. 86, P 〈 0. 0001 ], and less postoperative complications [ OR = 0.28, 95% CI：0. 19 - 0.42, P 〈 0.0001 ]. There were no significant differences between the two groups in hospital stay [ WMD = 0.17, 95% CI： - 0. 22 - 0.56, P = 0. 40] and mortality [ OR = 0. 88, 95% CI： 0. 30 - 2.64, P = 0.82 ]. Conclusion EVH factually reduces trauma in CABG, postoperative infection rate, postoperative pain, postoperative complications, and hospital stay, being applicable for high risk patients.