冠状动脉旁路移植术序贯和单一静脉桥通畅率荟萃分析

The patency of sequential and individual vein coronary bypass grafts

目的：比较冠状动脉旁路移植术（CABG）后序贯和单一大隐静脉桥通畅率。方法：检索PUBMED、EMBASE、The Cochrane Library及中国生物医学文献数据库。文献纳入标准：两组患者分别行序贯和单一大隐静脉CABG术;前瞻性或回顾性队列研究,须满足非随机研究方法组制定的队列研究特征;运用冠状动脉造影或超高速CT检查旁路移植术至少1个月以后桥血管通畅情况。文献纳入、数据提取和文献质量评定均由两名研究者独立完成。运用RevMan5.0和Stata10.0软件进行数据处理,合并相对危险度（RR）作为分析统计量,95%可信区间（CI）为判断结果标准。结果：12篇文献纳入本研究。序贯桥梗阻风险低于单一桥（13.56%vs.19.18%,RR=0.67,95%CI：0.60-0.74）;序贯桥中侧侧吻合梗阻风险低于端侧吻合（9.58%vs.14.07%,RR=0.52,95%CI：0.34-0.80）;序贯桥和单一桥中端侧吻合梗阻风险,差异无统计学意义（14.07%vs.13.61%,RR=0.85,95%CI：0.68-1.06）。结论：CABG后大隐静脉序贯桥中长期通畅率优于单一桥,序贯桥中侧侧吻合口通畅率优于端侧吻合口,序贯桥和单一桥端侧吻合口通畅率无差别。

Objective： To compare the mid-term or long-term patency of sequential vein coronary bypass grafts with those of single grafts. Methods： A comprehensive search strategy was run in PUBMED,EMBASE,the Cochrane Library and Chinese Biomedical Literature Database. This systematic review identified the following relevant MeSH and free terms for the interventions by literature review and by recommendations from experts in the field： coronary artery bypass,sequential,snake and jump. The languages of these searches were limited to English or Chinese. The search was also restricted to humans. There were no restrictions on publication year or type of publication. Inclusion criteria were the following：（ 1） two cohorts of patients received sequential and single saphenous vein coronary bypass grafting,respectively;（ 2） prospective or retrospective cohort design;and（ 3） graft patency examined by angiography or ultrafast computed tomography. Two researchers independently performed the literature search,data extraction and quality assessment. This systematic review chose to use the pooled estimate of the relative risk（ RR） as measure of effect,to analyze the results based on 95% confidence intervals（ CIs）,and to report two-sided p-values. The analysis was conducted using Rev Man5. 0 and Stata10. 0 software. Results： This systematic review identified 1,385 titles,reviewed 38 articles for inclusion criteria,and included 12 studies in the meta-analysis. The risk of occlusion in sequential grafts was lower（ RR= 0. 67,95% CI： 0. 60 - 0. 74） than that in single grafts. The risk of occlusion in side-to-side anastomoses was lower（ RR = 0. 52,95% CI： 0. 34 - 0. 80） than that of end-to-side anastomoses for sequential vein grafts.There was no difference in occlusion between the distal end-to-side anastomoses of sequential vein grafts and those of single ones（ RR = 0. 85,95% CI： 0. 68 - 1. 06）. Conclusion： The mid-term and long-term patency of sequential vein grafts appears to be better than that of single vein grafts and the patency of side-to-side anastomoses appears to be better than that of end-to-side anastomoses for sequential vein grafts.