经胸微创封堵与传统外科手术治疗室间隔缺损的Meta分析

摘要
图/表
参考文献(21)
相关文章 (1)

全文: PDF (1834 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的系统评价经胸微创封堵与传统外科手术治疗室间隔缺损的效果和安全性。方法计算机检索MEDLINE、PubMed、Ovid、CNKI、CSCD、WanFang Data、CBM数据库，查找国内外发表的关于比较经胸微创封堵与传统外科手术治疗室间隔缺损的对照试验，以“室间隔缺损、体外循环、外科手术、经胸封堵、经心室封堵”为检索词，检索时间从建库至2016年11月，采用RevMan 5.3软件进行Meta分析。结果共纳入16篇文献研究，合计3879例患者。Meta分析结果显示：经胸微创封堵手术成功率低于传统外科手术（OR = 0.14，95%CI：0.08～0.24，P ＜ 0.01），但手术并发症发生率少于传统外科手术（OR = 0.51，95%CI：0.30～0.86，P = 0.01），两者手术病死率、住院费用相当。经胸微创封堵在手术时间（MD = -64.69，95%CI：-73.41～-55.96，P ＜ 0.01）、术后呼吸机辅助呼吸时间（MD = -6.94，95%CI：-8.82～-5.06，P ＜ 0.01）、总住院时间（MD = -2.30，95%CI：-3.30～-1.31，P ＜ 0.01）等方面均短于传统外科手术，差异有统计学意义。结论经胸微创封堵较传统外科手术简单，安全，创伤小，恢复快，是治疗在适应证范围内的室间隔缺损的有效方法。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	谭启明秦良光于波陈洪晔张洁刘锦屏

关键词 ：室间隔缺损, 经胸微创封堵, 外科手术, 体外循环

Abstract：Objective To systematically review the efficacy and safety of minimally invasive transthoracic device closure versus conventional surgical repair in the treatment of ventricular septal defects. Methods The controlled trials concerning minimally invasive transthoracic device closure versus conventional surgical repair in the treatment of ventricular septal defects published at home and abroad were collected through searching medical databases such as MEDLINE, PubMed, Ovid, CNKI, CSCD, WanFang Data, CBM, using "ventricular septal defects, cardiopulmonary bypass, surgical repair, transthoracic device closure, perventricular device occlusion, perventricular device closure" for retrieval words from the date of establishment of the databases to November 2016. A meta-analysis was performed by using RevMan 5.3. Results Total 16 studies with 3879 patients were enrolled in this study. Meta analysis results showed that the operation success rate in the minimally invasive transthoracic device closure group was less than that of surgical repair group (OR = 0.14, 95%CI: 0.08-0.24, P ＜ 0.01), while the incidence of postoperative complications was lower than that of surgical repair group (OR = 0.51, 95%CI: 0.30-0.86, P = 0.01). The mortality rates and the hospitalization expenses were similar in both groups. The operation time (MD = -64.69, 95%CI: -73.41 - -55.96, P ＜ 0.01), postoperative respiratory machine auxiliary breathing time (MD = -6.94, 95%CI: -8.82 - -5.06, P ＜ 0.01) and the total length of hospital stay (MD = -2.30, 95%CI: -3.30 - -1.31, P ＜ 0.01) in the minimally invasive transthoracic device closure group were significantly shorter than those of surgical repair group, the differences were statistically significant. Conclusion Minimally invasive transthoracic device closure is simple, safe, with small trauma, rapid recovery compared with conventional surgical repair, which is an effective method in the treatment of ventricular septal defects within the scope of the indications.

Key words： Ventricular septal defect Minimally invasive transthoracic device closure Surgical repair Cardiopulmonary bypass

基金资助:江苏省连云港市第一人民医院青年英才豪森基金项目（QN160305）。

通讯作者: 秦良光（1963.10-），男，主任医师；研究方向：微创心脏外科。

作者简介: 谭启明（1981.5-），男，硕士；研究方向：微创心脏外科。

引用本文:

谭启明秦良光于波陈洪晔张洁刘锦屏. 经胸微创封堵与传统外科手术治疗室间隔缺损的Meta分析[J]. 中国医药导报, 2017, 14(20): 48-53.
TAN Qiming QIN Liangguang YU Bo CHEN Hongye ZHANG Jie LIU Jinping. Minimally invasive transthoracic device closure versus conventional surgical repair in the treatment of ventricular septal defects: a Meta-analysis. 中国医药导报, 2017, 14(20): 48-53.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I20/48

[1] Wan L，Yu BT，Wu QC，et al. Transthoracic closure of atrial septal defect and ventricular septal defect without cardio?鄄pulmonary bypass [J]. Genet Mol Res，2015，14（2）：3760-3766.
[2] Holzer RJ，Sallehuddin A，Hijazi ZM. Surgical strategies and novel alternatives for the closure of ventricular septal defects [J]. Expert Rev Cardiovasc Ther，2016，14（7）：831-841.
[3] Zhang GC，Chen Q，Chen LW，et al. Transthoracic echocar?鄄diographic guidance of minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass：initial experience [J]. Eur Heart J Cardiovasc Imaging，2012，13（9）：739-744.
[4] Xing Q，Pan S，An Q，et al. Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass：multicenter experience and mid-term follow-up [J]. J Thorac Cardiovasc Surg，2010， 139（6）：1409-1415.
[5] Downs SH，Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions [J]. J Epidemiol Community Health，1998，52（6）：377-384.
[6] 张玉展，李红昕，黄犇，等.室间隔缺损经胸微创封堵与体外循环直视手术疗效比较[J].中华实用诊断与治疗杂志，2011，25（12）：1233-1235.
[7] 胡振奎，吴伟敏，王强，等.室间隔缺损不同手术方式的对比研究[J].实用医学杂志，2011，27（18）：3363-3365.
[8] 王欣，赵天力，吴勤，等.经胸微创封堵术与体外循环下手术治疗室间隔缺损效果的比较[J].中华心血管病杂志，2012，40（10）：830-833.
[9] 徐帆，陈道中，陈良万，等.微创经胸室间隔缺损封堵术在婴幼儿中的应用[J].中国心血管病研究，2012，10（1）：12-15.
[10] 陈妙月，陈沅，李谧，等.小儿室间隔缺损3种不同手术方式的对比分析[J].重庆医科大学学报，2013，38（8）：896-900.
[11] 黄景思，郑世营，杨谦，等.室间隔缺损三种临床疗法的对比分析[J].浙江临床医学，2013，15（5）：603-605.
[12] 杨新超，柳德斌，王炜.经胸小切口封堵术与外科手术治疗膜部室间隔缺损的对比研究[J].中国心血管病研究，2014，12（4）：323-326，383.
[13] Zhu D，Lin K，Tang ML，et al. Midterm results of hybrid perventricular closure of doubly committed subarterial ventricular septal defects in pediatric patients [J]. J Card Surg，2014，29（4）：546-553.
[14] Hu S，Yang Y，Wu Q，et al. Results of two different appro?鄄aches to closure of subaortic ventricular septal defects in children[J]. Eur J Cardiothorac Surg，2014，46（4）：648-653.
[15] 王开标，刘德欣，李威.不同术式用于小儿室间隔缺损治疗的临床对比研究[J].中国现代医学杂志，2015，25（19）：87-90.
[16] 张学勤，邢泉生，武钦.经胸封堵与右腋下小切口直视修补婴幼儿膜周部室间隔缺损的结果对比[J].中华胸心血管外科杂志，2015，31（9）：527-532.
[17] Hu Y，Li Z，Chen J，et al. Results of comparing trans?鄄thoracic device closure and surgical repair with right infra-axillary thoracotomy for perimembranous ventricular septal defects [J]. Interact Cardiovasc Thorac Surg，2015，20（4）：493-498.
[18] Luo YK，Chen WH，Xiong C，et al. Comparison of effecti?鄄veness and cost between perventricular device occlusion and minimally invasive surgical repair for perimembran?鄄ous ventricular septal defect [J]. Pediatr Cardiol，2015，36（2）：308-313.
[19] Xing Q，Wu Q，Shi L，et al. Minimally invasive transt?鄄horacic device closure of isolated ventricular septal defects without cardiopulmonary bypass：long-term follow-up results [J]. J Thorac Cardiovasc Surg，2015，149（1）：257-264.
[20] Zhao YC，Hua C，Yuan JM，et al. Transfemoral and per?鄄ventricular device occlusions and surgical repair for doubly committed subarterial ventricular septal defects [J]. Ann Thorac Surg，2015，99（5）：1664-1670.
[21] 陈健，刘建实.经胸微创封堵与传统修补术治疗婴幼儿室间隔缺损的临床效果比较[J].天津医药，2016，44（7）：898-902.