摘要
目的系统评价经导管与外科手术治疗继发孔型房间隔缺损的临床研究数据。方法计算机检索Pub Med、EMbase、MEDLINE、Cochrane图书馆、CBM、万方数据库及CNKI,纳入经导管与外科手术治疗继发孔型房间隔缺损的随机对照研究(RCT)和队列研究。由两名评价员按照纳入与排除标准筛选文献,提取资料和评价质量后,采用Cochrane协作网提供的Rev Man5.3统计软件进行Meta分析。结果共纳入28篇队列研究(共计14 741例患者)。导管组全因死亡率、并发症发生率、住院时间均低于外科手术组,差异均有统计学意义(OR 0.36,95%CI 0.21~0.59,P<0.0001;OR 0.37,95%CI 0.25~0.55,P<0.0001;WMD–3.77,95%CI–4.36~–3.18 P<0.00001)。导管组残余分流发生率、再次干预率高于外科手术组,差异均有统计学意义(OR 3.55,95%CI 1.79~7.05,P=0.0003)、(OR 2.19,95%CI 1.31~3.65,P=0.003)。结论两种手术方式都是有效的,与外科手术封堵相比,经导管介入封堵治疗继发孔型房间隔缺损具有低死亡率、低并发症发生率以及低住院时间等优势,而外科手术组在残余分流发生率及再次干预率方面有一定优势。
Objective To summarise data from studies comparing transcatheter closure（TCC）versus surgical closure（SC） of secundum atrial septal defects（ASDs）. Methods Databases including Pub Med, EMBASE, MEDLINE, the Cochrane Library, CMB and CNKI were searched to enroll randomized controlled trials（RCTs） and cohort study trials（CSTs） comparing the two methods of closure（transcatheter versus surgical）.The literature was screened according to the inclusive and exclusive criteria by two reviewers independently. The quality of the trials was evaluated. The data were extracted and meta-analysis was performed using Rev Man 5.3 sof tware. Results 28 original studies（14,741 patients） were included. All studies were non-randomised. TCC was found to be superior to SC in the following outcomes： all-cause mortality（OR 0.36,95% CI 0.21-0.59,P〈0.0001）, total complications（OR 0.37,95% CI 0.25-0.55,P〈0.0001）, and length of stay（WMD –3.77,95%CI –4.36-–3.18,P〈0.00001）. Residual shunts were more common with TCC（OR 3.55,95% CI 1.79-7.05,P=0.0003）. There was a statistically signifi cant difference between TCC and SC（OR 2.19, 95% CI 1.31-3.65, P=0.003）. Conclusions Both approaches are effective for closure ASDs.Transcatheter is associated with lower mortality, complications, and length of stay while surgical closure has a lower rate of residual shunting.
作者
王宝珠
孟凡华
马翔
马依彤
WANG Bao-zhu;MENG Fan-hua;MA Xiang;MA Yi-tong(Department of Heart Center,The First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China)
出处
《中国介入心脏病学杂志》
2018年第8期447-456,共10页
Chinese Journal of Interventional Cardiology
关键词
经导管
外科手术
房间隔缺损
META分析
Transcatheter closure
Surgical closure
Atrial septal defect
Meta analysis
