经皮封堵和开胸修补治疗继发孔型房间隔缺损疗效比较的Meta分析

Meta-analysis of the efficacy of transcutaneous closure and thoracotomy for the treatment of atrial septal defect

目的:系统评价经皮封堵和开胸修补两种术式治疗房间隔缺损的安全性和有效性。方法:计算机检索PubMed、CochraneLibrary、VIP、WanfangData和CNKI数据库,查找关于经皮封堵和开胸修补治疗房间隔缺损相关研究文献,检索时限均从建库至2018年6月。由两位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan5.3软件进行Meta分析。结果:共纳入45个研究,2210例患者。Meta分析结果显示:经皮封堵治疗房间隔缺损在术后总并发症发生率[RR=0.30,95%CI(0.24,0.37)]、主要并发症发生率[RR=0.27,95%CI(0.20,0.37)]、心律失常发生率[RR=0.40,95%CI(0.30,0.52)]、心包积液发生率[RR=0.16,95%CI(0.09,0.28)]、手术时间[SMD=-3.23,95%CI(-4.04,-2.43)]、总住院时间[SMD=-2.74,95%CI(-3.16,-2.32)]、术后住院时间[SMD=-4.99,95%CI(-6.60,-3.39)]比较中均优于开胸修补,而在手术成功率[RR=0.98,95%CI(0.97,0.99)]、残余分流发生率[RR=1.73,95%CI(1.05,2.85)]、手术花费[SMD=1.86,95%CI(1.06,2.66)]比较中外科修补占优势。结论:现有证据表明,经皮房间隔缺损封堵术较传统开胸房间隔缺损修补术对患者创伤小,手术时间短,患者术后恢复良好,并发症发生率低,值得临床进一步推广应用。

Objective:To systematically evaluate the safety and effectiveness of transcatheter closure and thoracotomy in the treatment of atrial septal defect. Methods: The database of PubMed,the Cochrane Library,VIP,Wanfang Data and CNKI was searched by computer for relevant research literature. The retrieval time was from database establishment to June 2018.Two reviewers independently screened the literature,extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was performed using Rev Man 5.3 software. Results: A total of 45 studies and 2210 patients were included. Meta-analysis showed that the incidence of total complications[RR=0.30,95%CI(0.24,0.37)],major complications[RR=0.27,95%CI(0.20,0.37)],incidence of arrhythmia[RR=0.40,95%CI (0.30,0.52)],incidence of pericardial effusion[RR=0.16,95%CI(0.09,0.28)],operation time[SMD=-3.23,95%CI(-4.04,-2.43)], total hospital stay[SMD=-2.74,95%CI(-3.16,-2.32)],and post-operative stay[SMD=-4.99,95%CI(-6.60,-3.39)]in patients with atrial septal defect treated by percutaneous occlusion was superior to thoracotomy.Surgical repair had advantages in the success rate of operation [RR =0.98,95%CI(0.97,0.99)],the incidence of residual shunt[RR=1.73,95%CI(1.05,2.85)]and the cost of operation[SMD=1.86, 95%CI (1.06,2.66)]. Conclusion: Current evidence shows that percutaneous atrial septal defect occlusion is less traumatic, shorter operation time, better recovery and lower complication rate than traditional thoracotomy atrial septal defect repair. It is worthy of further promotion and application in clinic.