冠状动脉旁路移植术中内窥镜下获取桡动脉有效性和安全性的Meta分析

Efficacy and Safety of Endoscopic Radial Artery Harvesting for Coronary Artery Bypass Grafting:A Meta-analysis

目的系统评价冠状动脉旁路移植术(CABG)术中通过内窥镜获取桡动脉的有效性和安全性。方法计算机检索The Cochrane Library(2015第2期)、Pub Med、EMbase、CBM、CNKI、Wan Fang Data和VIP数据库,搜集有关CABG术中通过内窥镜获取桡动脉与采用传统切开获取桡动脉有效性和安全性比较的随机对照试验(RCT)和队列研究,检索时限均为从建库至2015年8月。由2位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果纳入12个队列研究,包括1 359例患者。Meta分析结果显示:内窥镜组与传统切开组在围术期死亡率[OR=0.66,95%CI(0.17,2.57),P=0.55]、术后心肌梗死发生率[OR=0.78,95%CI(0.30,2.06),P=0.62]、血管桥通畅率[OR=1.40,95%CI(0.80,2.45),P=0.24]及切口感染发生率[OR=0.59,95%CI(0.33,1.07),P=0.08]方面差异无统计学意义,但内窥镜组的血肿形成发生率[OR=0.39,95%CI(0.20,0.74),P=0.004]和感觉异常发生率[OR=0.44,95%CI(0.22,0.88),P=0.02]明显低于传统切开组,且差异有统计学意义。结论当前证据显示,与CABG术中切开获取桡动脉相比,通过内窥镜获取桡动脉的术后血肿形成发生率和感觉异常发生率明显更低。受纳入研究质量和数量所限,上述结论尚需开展更多高质量的RCT加以验证。

Objective To systematically review the efficacy and safety of endoscopic radial artery harvesting for coronary artery bypass grafting （CABG）. Methods Databases including The Cochrane Library （Issue2, 2015）, PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to August 2015 to collect randomized controlled trials （RCTs） and cohort studies about endoscopic radial artery harvesting technique versus traditional incision technique for CABG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. Results A total of 12 studies involving 1 359 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in perioperative mortality （OR=0.66, 95%CI 0.17 to 2.57, P=0.55）, the incidence of postoperative myocardial infarction （OR=0.78, 95%CI 0.30 to 2.06, P=0.62）, vascular graft patency rate （OR=1.40, 95%CI 0.80 to 2.45, P=0.24） and the incidence of wound infection （OR=0.59, 95%CI 0.33 to 1.07, P=0.08）. The endoscopic group showed significantly lower incidence of hematoma formation （OR=0.39, 95%CI 0.20 to 0.74, P=0.004） and paresthesia （OR=0.44, 95%CI 0.22 to 0.88, P=0.02） than that of the incision group. Conclusion Current evidence shows that, compared with the incision technique, the endoscopic radial artery harvesting could significantly reduce the incidence of hematoma formation and paresthesia in patients underwent CABG. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more high-quality studies.