电视胸腔镜和开胸直视修补治疗房间隔缺损疗效比较的Meta分析

The efficacy of video-assisted thoracoscopic and open-heart repair for atrial septal defect: a systematic review and Meta-analysis

目的系统评价电视胸腔镜和开胸直视修补两种术式治疗房间隔缺损(atrial septal defect,ASD)的安全性和有效性。方法计算机检索PubMed、Cochrane Library、Embase、VIP、Wanfang Data和CNKI数据库,查找关于电视胸腔镜和开胸直视修补治疗ASD相关研究文献,检索时限均从2000年1月至2018年8月。由2位评价员按纳入标准与排除标准独立筛选文献、提取资料并评价文献质量后,采用RevMan 5.3软件进行Meta分析。结果共纳入28项研究2 386例患者。Meta分析结果显示:电视胸腔镜和开胸直视修补治疗ASD在总并发症发生率比较中无差异[RR:0.58(0.34,1.00),P=0.05],电视胸腔镜下修补在术中输血[SMD:-1.10(-2.00,-0.21)]、ICU停留时间[SMD:-0.73(-1.07,-0.39)]、机械通气时间[SMD:-0.60(-0.84,-0.36)]、手术切口总长度[SMD:-1.54(-2.11,-0.98)]、术后引流量[SMD:-1.84(-2.31,-1.36)]、总住院时间[SMD:-1.00(-1.37,-0.63)]和术后住院时间[SMD:-1.14(-1.51,-0.76)]的比较中明显减少,而在手术时间[SMD:0.62(0.06,0.19)]、体外循环时间[SMD:1.47(1.05,1.88)]、主动脉阻断时间[SMD:0.94(0.70,1.18)]和手术花费[SMD:2.73(0.84,4.62)]较开胸直视修补增加。结论电视胸腔镜下修补较开胸直视修补治疗ASD的手术时间和体外循环时间略有延长,但避免了开胸对机体带来的伤害,患者术后恢复时间较快且住院时间缩短,可作为ASD的微创治疗方案遵循患者意愿加以使用。

Objective To systematically evaluate the safety and effectiveness of video-assisted thoracoscopic repair and open-heart repair for atrial septal defect (ASD). Methods The database of PubMed, The Cochrane Library, Embase, VIP, Wanfang Data and CNKI was searched by computer for relevant research literature. The retrieval time was from Jan.2000 to Aug. 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 28 studies including 2 386 patients were included. Meta-analysis showed that there was no difference in the total complication rate between video-assisted thoracoscopic repair and surgical repair for atrial septal defect. Video-assisted thoracoscopic repair decreased significantly in the comparison of operative time, intraoperative blood transfusion, ICU stay, mechanical ventilation time, total length of surgical incision, postoperative drainage, total hospitalization time and post-operative hospitalization time. External circulation time, aortic occlusion time and operation cost were higher than those of open-heart repair. Conclusions The existing evidence shows that the operation time and cardiopulmonary bypass time of video-assisted thoracoscopic repair for ASD are slightly longer than that of open-heart repair, but the injury caused by open-heart repair is avoided partially. The patients recover quickly and the hospital stay is shortened. It can be used as a minimally invasive treatment for atrial septal defect according to the wishes of patients.