超声与DSA引导经皮封堵治疗房间隔缺损疗效的比较:meta分析

The efficacy of transcatheter closure of atrial septal defect guided by echocardiography and DSA:a meta-analysis

目的:系统评价超声与数字减影血管造影(DSA)引导下经皮封堵治疗房间隔缺损的临床疗效及安全性。方法:计算机检索PubMed、The Cochrane Library、Embase、VIP、万方和中国知网数据库中关于超声与DSA介入引导经皮封堵房间隔缺损手术的相关文献,检索时间范围均为2005年1月—2020年8月。由2位评价员独立筛选文献、提取数据并进行质量控制后,采用RevMan5.4软件进行Meta分析。结果:共纳入14项相关文献,其中包括行超声引导术患者共749例,行DSA引导患者共957例。meta分析结果显示,两组在手术成功率(RR=0.00,95%CI:-0.01~0.02,P=0.56)、术后并发症(RR=-0.02,95%CI:-0.06~0.01,P=0.20)、术后残余分流(RR=-0.01,95%CI:-0.03~0.01,P=0.16)、手术时间(SMD=0.48,95%CI:-0.97~1.93,P=0.52)方面均无统计学差异。分别分析经胸超声和DSA经皮介入封堵术(SMD=-1.12,95%CI:-2.15~-0.09,P=0.03)、经食管超声与DSA经皮介入术的手术费用(SMD=0.54,95%CI:0.27~0.81,P=0.0001),随机效应模型显示合并效应值均差异有统计学意义。结论:超声引导经皮房间隔缺损封堵术是一种安全、有效、费用低廉,较为理想的微创治疗方式,值得临床推广应用。

Objective:To systematically evaluate the clinical efficacy and safety of transcatheter closure of atrial septal defect guided by ultrasound and digital subtraction angiography(DSA).Metheds:PubMed,the Cochrane Library,Embase,VIP,Wanfang,and CNKI databases were searched for relevant literatures on ultrasound and DSA guided percutaneous closure of atrial septal defect,the retrieval time was from January 2005 to August 2020.Two assessors independently screened literatures,extracted data,and evaluated the quality.The RevMan5.4 software was used for the meta-analysis.Results:A total of 14 studies were included,with 749 patients in ultrasound group and 957 patients in DSA group.The meta-analysis showed that there was no significant difference in the success rate(RR=0.00,95%CI:-0.01 to 0.02,P=0.56),postoperative complications(RR=-0.02,95%CI:-0.06 to 0.01,P=0.20),residual shunt(RR=-0.01,95%CI:-0.03 to 0.01,P=0.16),and operation time(SMD=0.48,95%CI:-0.97 to 81.93,P=0.52)between the ultrasound group and DSA group.The combined effect values about the operation costs of transthoracic ultrasound and DSA interventional occlusion(SMD:-1.12,95%CI:-2.15 to-0.09,P=0.03),transesophageal ultrasound and DSA intervention(SMD:0.54,95%CI:0.27 to 0.81,P=0.0001)were statistically significant.Conclusion:Ultrasound guided percutaneous closure of atrial septal defect is a safe,effective,low-cost,and relatively ideal minimally invasive treatment,which is worthy of further clinical promotion and application.