经胸微创封堵与传统外科手术治疗房间隔缺损的Meta分析

Minimally Invasive Transthoracic Device Closure Versus Conventional Surgical Repair in the Treatment of Atrial Septal Defects:A Meta-Analysis

目的系统评价经胸微创封堵与传统外科手术治疗房间隔缺损(ASD)的疗效和安全性。方法计算机检索美国国家医学图书馆(Pubmed)、Cochrane图书馆(CL)、生物医学与药理文摘数据库(EMBASE数据库)、中国期刊全文数据库及万方数据库,以"房间隔缺损、体外循环、外科手术、经胸封堵"为检索词,检索范围为建库至2017年9月;采用RevMan5.3软件进行Meta分析。结果共纳入8篇文献报道,1 018例患者。Meta分析显示,2种手术方式在成功率、病死率、手术并发症发生率、严重并发症发生率相当。经胸微创组在心律失常发生率、手术时间、术后ICU住院时间、住院时间均小于传统外科手术(P<0.01);但经胸微创组术后残余分流发生率高于传统外科手术组(P<0.05)。结论经胸微创封堵较传统外科手术简单,手术创伤小,术后恢复快,能安全、有效地治疗ASD。

Objective To systematically review the efficacy and safety of minimally invasive transthoracic device closure versus conventional surgical repair in the treatment of atrial septal defects. Methods We systematically searched EMBASE,PubMed,the Cochrane library,CNKI,and Wanfang,using“atrial septal defects,Cardiopulmonary bypass,surgical repair,and transthoracic device closure”for retrieval words from inception of each database to September 1st,2017. The RevMan 5.3 software was used in data processing. Results Total 8 studies with 1018 cases were enrolled in this study. Meta-analysis results showed that the operation success rate,the incidence of postoperative complication,the incidence of major complications,and the mortality rates were similar in both groups. The incidence of arrhythmia(OR=0.43,95%CI:0.28～0.66,P=0.000 1),the operation time(OR=-74.66,95%CI:-81.28～-68.04,P<0.000 1),ICU stay(OR=-74.66,95%CI:-13.25～-68.04,P<0.000 1),the total length of hospital stay(OR=-2.88,95%CI:-4.28～-1.47,P<0.000 1)in minimally invasive transthoracic device closure group were lower than that in conventional surgical repair group with statistical significance. However,the incidence of postoperative residual shunt in minimally invasive transthoracic device closure group(OR=2.69,95%CI:1.10～6.58,P=0.03)was higher than that in conventional surgical repair group with statistical significances. Conclusion Minimally invasive transthoracic device closure can treat ASD safely and effectively. Compared with conventional surgical repair,it has advantage of less operation trauma,faster recovery,and less hospital expense.