两种方法治疗完全性房室隔缺损手术效果的系统评价与Meta分析

Comparision of Two Techniques Used in Complete Atrioventricular Septal Defects:A Systematic Review and Meta-analysis

目的系统评价改良单片法在完全性房室隔缺损术中和术后疗效的优势。方法计算机检索PubMed和Annual Reviews、中国知网、万方数据库、读秀学术搜索等数据库查找文献,检索日期截至2016年3月,根据纳入标准对文献进行筛选和评估,采用STATA 11.0软件进行Meta分析,比较双片法和改良单片法术中和术后疗效,结果以平均差(SMD),合并RR值和95%可信区间(CI)表示。结果 Meta分析结果提示,改良单片法在体外循环时间、主动脉阻断时间、住院时间和住ICU时间、死亡人数上较双片法有显著优势(SMD=-0.93,95%CI-1.24^-0.61,P=0.000;SMD=-1.02,95%CI-1.39^-0.66,P=0.000;SMD=-0.10,95%CI-0.43^-0.23,P=0.035;SMD=-0.12,95%CI-0.29^-0.05,P=0.555;RR=0.93,95%CI 0.66~1.30,P=0.031),而再次手术率方面,差异无统计学意义(RR=0.87,95%CI 0.65~1.17,P=0.398)。结论改良单片法较双片法在手术时间及住院时间的缩短、死亡率的减少上有较大优势,同时可以减少因为体外循环而带来的相关并发症,但再次手术率差异无统计学意义。

Objective To systemically evaluate the advantage of simplified single-patch technique used in complete atrioventricular septal defects. Methods A systematic literature search was conducted in PubMed, Annual Reviews, CNKI, Wanfang Data Libraries and Read Show Academic Search, and the retrieval date was March 2016. The literatures were screened and assessed according to inclusion criteria, and analyzed by meta-analysis STATA 11,0 software. The results were represented in standard mean difference （SMD）, risk ratio （RR） and 95% confidence interval （CI）. Results Compared with the two-patch technique group, in the simplified single-patch technique group cardiopulmonary bypass time, aortic clamping time, the length of hospital stay and the ICU stay as well as the mortality rate were satistically less （SMD=-0.93, 95% CI -1.24, -0.61, P=0.000; SMD=-1.02, 95% CI -1.39, -0.66, P=0.000; SMD=-O.IO, 95% CI -0.43, -0.23, P=0.035; SMD=-0.12, 95% CI -0.29, -0.05, P=0.555; RR=0.93, 95% CI 0.66, 1.30, P=0.031, respectively）. While there was no statistical difference in the reoperation rate （RR=0.87, 95% CI 0.65, 1.17, P=0.398）. Conclusion Simplified single-patch technique has dominant superiority in operation time, ICU stay, mortality rate, and correlative complications induced by extracorporeal circulation. However, difference in reoperation rate is not significant.