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

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.%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MED-LINE、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.