头颈部游离组织瓣移植术中微血管吻合装置应用的Meta分析

Meta-analysis of the application of microvascular anastomotic device in free tissue flap transfer of head and neck

目的评价微血管吻合装置(MVAD)在头颈部游离组织瓣移植术中应用的临床效果。方法计算机检索PubMed、Medline、Web of Science、Cochrane Database of Systematic Reviews、Cochrane Central Register of Controlled Trials、万方、CNKI等数据库,搜集自1962年1月1日至2020年4月1日发表的关于游离组织瓣修复头颈部组织缺损中血管吻合方式的中、英文研究,严格评价纳入研究的文献质量,应用R统计软件(R-4.0.0)对数据进行整合分析。结果共纳入16篇研究,包括1项随机对照研究和15项回顾性病例系列研究。Meta分析结果显示:在头颈部游离组织瓣移植术中,MVAD与手工缝合在吻合后血栓(或血管危象)发生率方面差异无统计学意义[RR=1.10,95%CI(0.71,1.69),P>0.05];应用MVAD行静脉端端吻合后血栓(或血管危象)发生率较低[RR=0.26,95%CI(0.11,0.62),P<0.05];MVAD与手工缝合相比行静脉(或动脉)吻合的时间明显缩短[WMD=10.78,95%CI(10.55,11.01),P<0.05;WMD=15.26,95%CI(14.65,15.87),P<0.05]。结论应用MVAD行静脉端端吻合血栓(或血管危象)发生率较低,应用MVAD能明显缩短静脉(或动脉)吻合时间。

Objective To evaluate the clinical efficacy of microvascular anastomotic device(MVAD)in free tissue flap transfer of head and neck with Meta-analysis.Methods PubMed,Medline,Web of Science,Cochrane Database of Systematic Reviews,Cochrane Central Register of Controlled Trial,Wanfang,CNKI were searched from 1 January,1962 to 1 April,2020 for all publications in Chinese and English about vascular anastomosis in head and neck reconstruction with free flap.The quality of included studies was critically assessed.Statistical software R(R-4.0.0)was used for data analysis and synthesis.Results A total of 16 studies including 1 randomized controlled trial and 15 retrospective case study series met the inclusion criteria.The result of Meta-analysis revealed that the difference in the risk of thrombosis or vascular compromise was not statistically significant between microvascular coupler and hand-sewn group[RR=1.10,95%CI(0.71,1.69),P>0.05].The subgroup analysis revealed that venous coupler could reduce the risk of venous thrombosis or compromise in end-to-end anastomosis[RR=0.26,95%CI(0.11,0.62),P<0.05].MVAD could significantly shorten the time of anastomosis when compared with hand-sewn in arterial and venous anastomosis[WMD=10.78,95%CI(10.55,11.01),P<0.05;WMD=15.26,95%CI(14.65,15.87),P<0.05].Conclusion MVAD can reduce the risk of venous thrombosis or compromise,and significantly shorten the time of arterial and venous anastomosis.