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|本期目录/Table of Contents|

比较两种手术治疗先天性心脏病疗效的Meta分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第3期
页码:
373-379
栏目:
临床研究
出版日期:
2013-06-25

文章信息/Info

Title:
Totally thoracoscopic surgery versus median sternotomy in treating congenital heart diseases: A Metaanalysis
作者:
王石雄1; 赵启明1; 曹云华2; 李宁荫3; 高秉仁1; 吴向阳1; 柳德斌1
(兰州大学第二医院：1.心脏外科，2.门诊部，3.心内科，甘肃 兰州 730000)
Author(s):
WANG Shi xiong1;  ZHAO Qi ming1;  CAO Yun hua2;  LI Ning yin3;  GAO Bing ren1;  WU Xiang yang1;  LIU De bin1
(1.Department of Cardiac Surgery, 2.Outpatient department, 3.Department of Cardiology, Second Hospital, Lanzhou University, Lanzhou 730000, Gansu, China)
关键词:
完全胸腔镜手术; 胸骨正中切口; 心脏病; 先天性; 房间隔缺损; 室间隔缺损; Meta分析
Keywords:
totally thoracoscopic surgery;  median sternotomy;  congential heart disease;  atrial septal defect;  ventricular septal defect;  Meta analysis
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:通过Meta分析评价完全胸腔手术(totally thoracoscopic surgery,TTS)与常规胸骨正中切口心内直视手术(median sternotomy,MS)两种术式治疗先天性心脏病(congenital heart diseases,CHD)的疗效。方法:计算机检索PubMed、Embase、Cochrane Library(2012年第7期)、VIP、CNKI、CBM和万方数据库，查找所有比较TTS和MS治疗先天性心脏病的随机对照试验(randomized controlled trials,RCT)与临床对照研究(controlled clincal trials,CCT)，检索时限均为建库至2012年6月。同时手检纳入文献的参考文献，语种限制为中文和英文。按纳入排除标准由两人独立进行文献的筛选、资料提取和质量评价，最后将提取的资料采用RevMan 5.1软件进行Meta分析。结果:共纳入9个研究，包括3个RCT和6个CCT；共748例患者，其中TTS组364例，MS组384例。Meta分析结果显示：TTS组在呼吸机辅助呼吸时间加权均数差[(WMD)=-1.17,95%CI（-2.15,-0.20),P=0.02]、ICU时间[WMD=-12.22,95%CI(-17.34,-7.10),P<0.01]、胸腔闭式引流量[WMD=-2.36,95%CI(-3.42,-1.18),P<0.01]和住院时间[WMD=-1.92,95%CI(-2.69,-1.16)，P<0.01]上都明显低于MS组，而主动脉阻断时间[WMD=5.70,95%CI(1.33,10.07),P=0.01]和CPB时间[WMD=13.08,95%CI(3.48,22.69),P<0.01]长于MS组，但是在手术时间[WMD=0.25,95%CI(-0.18,0.69),P>0.05]和术后并发症[OR=1.21, 95%CI(0.50,2.92),P>0.05]两组差异无统计学意义。结论:TTS治疗先天性心脏病安全有效，创伤小，术后恢复快，美容效果好。
Abstract:
AIM:To evaluate the efficacy and safety of totally thoracoscopic surgery (TTS) and median sternotomy (MS) in treating congenital heart diseases (CHD). METHODS: Databases of PubMed, Embase, Cochrane Library (Issue 7, 2012), VIP, CNKI, CBM and Wanfang were searched from the date of database establishment to June 2012 for randomized controlled trials (RCTs) and controlled clincal trials (CCTs) concerning the treatment of CHD, and the references of those studies were also searched by hand. The language was limited to the Chinese and English. After selection, data extraction and quality assessments were conducted by two reviewers independently and meta analyses were performed using RevMan 5.1 software. RESULTS: A total of nine studies involving 364 TTS patients and 384 MS patients met the inclusion criteria. Of these 9 studies, three studies were RCTs and the other six studies were CCTs. The results of metaanalyses showed that the TTS group had a better postoperative effect, and the time of mechanical respiration (WMD=-1.17, 95%CI -2.15 to -0.20, P<0.05), the time of ICU (WMD=-12.22, 95%CI -17.34 to -7.10, P<0.01), the chesttube drainage (WMD=-2.36, 95%CI -3.42 to -118, P<001) and the hospitalization days (WMD=-1.92, 95%CI -2.69 to -1.16, P<0.01) in TTS group were less than those in MS group, but the aorta cross clamping time (WMD=5.70, 95%CI 1.33 to 10.07, P=0.01) and the bypass time (WMD=13.08, 95%CI 3.48 to 22.69, P<0.01) in TTS group were longer than those in MS group. The operating time (WMD=0.25, 95%CI -0.18 to 069, P=0.25) and the incidence of postoperative complications (OR=1.21, 95%CI 0.50 to 2.92, P>0.05 ) were not significantly different between the two groups. CONCLUSION: TTS in treating CHD is feasible and safe with less trauma, quicker recovery and good cosmetic results.

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备注/Memo

备注/Memo:
收稿日期：2012-12-16.
通讯作者：赵启明，副主任医师，主要从事心脏疾病临床与基础研究 Email:clint0251@163.com 作者介绍：王石雄，住院医师,硕士 Email: wangshi0815@163.com
更新日期/Last Update: 2013-07-16