微创右胸小切口与传统正中开胸行二尖瓣置换术有效性和安全性的Meta分析

Effectiveness and safety of minimally invasive mitral valve replacement via right minithoracotomy and traditional mitral valve replacement: a Meta-analysis

目的系统评价微创右胸小切口行二尖瓣置换术的有效性和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2014第2期)、CBM、CNKI、Wan Fang Data和VIP,收集有关微创右胸小切口行二尖瓣置换术的队列研究,检索时限均为从建库至2014年6月,由两位评价者按照纳入与排除标准独立选择文献、提取资料和方法学质量评价后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入7个研究,共计1372例患者,Meta分析结果显示:与传统组相比,微创组延长了术中体外循环时间[SMD=0.41,95%CI(0.16,0.66),P=0.001]和主动脉阻断时间[SMD=0.49,95%CI(0.13,0.84),P=0.007],但在术后住院时间[SMD=-0.84,95%CI(-1.25,-0.43),P<0.000 01]、术后ICU住院时间[SMD=-0.54,95%CI(-0.90,-0.17),P=0.004]及术后引流量[SMD=-1.89,95%CI(-3.21,-0.58),P=0.005]显著少于传统组,两组差异均有统计学意义。术后呼吸机使用时间[SMD=-0.64,95%CI(-1.32,0.04),P=0.06]及围术期死亡率[OR=0.56,95%CI(0.18,1.77),P=0.33]方面,两组差异无统计学意义。结论微创右胸小切口二尖瓣置换术创伤小、恢复快、安全有效,值得临床推广应用。受纳入研究质量和数量所限,上述结论仍需开展更多高质量前瞻性的试验设计加以验证。

Objective To systematically review the efficacy and safety of minimally invasive mitral valve replacement via right minithoracotomy. Methods Databases including PubMed, EMbase, The Cochrane Library （ Issue 2,2014）, CBM, CNKI, WanFang Data and VIP were searched electronically from their inception to June 2014. Two reviewers identified the literature independently according to inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, Meta-analysis was performed using RevMan 5.2 software. Results A total of seven studies involving 1372 cases were included. The results of Meta-analysis showed that： compared with traditional group, minimally invasive group prolonged cardiopulmonary bypass time [ SMD = 0. 41, 95% CI（0. 16,0. 66） ,P =0. 0011 ,and aortic clamping time [ SMD = 0. 49,95% CI（0. 13,0. 84） ,P =0O. 007 ], but the postoperative hospital stay [ SMD = -0. 84,95 % CI（ - 1.25, -0. 43 ）, P 〈 0. 000 011, postoperative ICU stay [SMD = -0. 54,95% CI（ -0. 90, -0. 17） ,P =0. 004] and postoperative drainage [SMD = -1.89,95% CI （ - 3.21, - 0. 58 ）, P =0. 005 1 in minimally invasive group were significantly less than that in the traditional group, the difference was statistically significant. There was no statistical significance in postoperative mechanical ventilation time [ SMD = - 0. 64,95% CI（ - 1.32,0.04） ,P = 0.06 ] and perioperative mortality[ OR = 0. 56,95% CI（0. 18,1.77） ,P = 0. 33 ]. Conclusion Minimally invasive mitral valve replacement via right minithoracotomy has the disadvantages of minor trauma, quicker recovery, safe and effective and is worthy of promotion. Due to the quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality prospective trial designs.