摘要
目的系统评价完全胸腔镜与正中开胸房间隔缺损修补术疗效的有效性和安全性。方法计算机检索The Cochrane Library(2016年2期)、Pub Med、EMbase、CBM、CNKI、Wan Fang Data和VIP数据库,搜集有关完全胸腔镜与正中开胸房间隔缺损修补术比较的随机对照试验(RCT)和队列研究,检索时限均为从建库至2016年6月。由2位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入11个队列研究,共687例患者,其中全胸腔镜组305例,正中开胸组382例。Meta分析结果显示:胸腔镜组在术后呼吸机辅助时间[MD=–1.49,95%CI(–2.27,–0.71),P=0.000 2]、术后重症监护室时间[MD=–7.30,95%CI(–12.07,–2.53),P=0.003]和住院天数[MD=–2.06,95%CI(–2.80,–1.32),P<0.000 01]上明显短于开胸组,术后引流量明显少于开胸组[MD=–199.83,95%CI(–325.96,–73.70),P=0.002],但在体外循环时间[MD=9.42,95%CI(1.55,17.30),P=0.02]和主动脉阻断时间[MD=6.78,95%CI(3.48,10.07),P<0.000 1]上明显长于开胸组。结论完全胸腔镜下房间隔缺损修补术跟传统开胸正中切口房间隔缺损修补术相比,可明显减少术后引流量,缩短术后呼吸机辅助时间、重症监护室停留时间、住院天数,但有延长体外循环时间和主动脉阻断时间的风险。受纳入研究质量和数量的限制,上述结论仍需开展更多前瞻性高质量研究加以验证。
Objective To systematically review the efficacy and safety of totally thorascopic（TT） and median sternotomy（MS） approaches for atrial septal defect repair（ASDR）. Methods Databases including The Cochrane Library（Issue 2, 2016）, Pub Med, EMbase, CBM, CNKI, Wan Fang Data and VIP were electronically searched from inception to June 2016, to collect randomized controlled trials or cohort studies about TT vs. MS approaches for ASDR. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using Rev Man 5. 2 software. Results A total of 11 cohort studies involving 687 patients were included with 305 patients in the TT group, and 382 patients in the MS group. The results of meta-analysis showed that： The TT group had shorter postoperative ventilation time（MD= – 1. 49, 95 %CI – 2. 27 to – 0. 71, P= 0. 000 2）, postoperative ICU stay time（MD= – 7. 30, 95 %CI – 12. 07 to – 2. 53, P= 0. 003）, hospital stay time（MD= – 2. 06, 95 %CI – 2. 80 to – 1. 32, P〈0. 000 01） and less postoperative drainage（MD= – 199. 83, 95 %CI – 325. 96 to – 73. 70, P= 0. 002） than the MS group. But the bypass time（MD= 9. 42, 95 %CI 1. 55 to 17. 30, P= 0. 02） and aortic clamping time（MD 6. 78, 95 %CI 3. 48 to 10. 07, P〈0. 000 1） of the TT group were significantly longer than those of the MS group. Conclusion Compared with MS, TT can significantly reduce the length of postoperative ventilation, postoperative ICU stay, hospital stay and postoperative drainage. But there are risks of prolonged bypass time and aortic clamping time in the TT group. Due to the quantity and quality of the included studies, the above conclusions still needs to be verified by carrying out more studies.
出处
《中国循证医学杂志》
CSCD
2016年第10期1169-1175,共7页
Chinese Journal of Evidence-based Medicine
关键词
房间隔缺损
胸腔镜手术
微创手术
心脏手术
系统评价
META分析
队列研究
Atrial septal defect
Thoracoscope surgery
Minimally invasive surgery
Cardiac surgery
Systematic review
Meta analysis
Cohort study
