风湿性心脏病二尖瓣成形术与置换术的系统评价

摘要

目的 系统评价风湿性心脏病二尖瓣成形术与置换术的疗效,为临床治疗提供循证参考.方法 计算机检索The Cochrane Library、PubMed、EMbase、中国生物医药数据库、中国期刊全文数据库、维普数据库、万方数据库,从建立数据库到2017年2月,对相关风湿性心脏病二尖瓣成形术与置换术的临床对照研究进行收集和筛选,提取资料并评价质量,采用RevMan 5.3统计软件对30 d死亡率、长时间随访生存情况、再手术情况和术后主要不良事件情况进行Meta分析.结果 共纳入11篇文献,总病例数4287例,其中二尖瓣成形组1465例,二尖瓣置换组2822例.Meta分析结果显示,二尖瓣成形组30 d死亡率(OR=0.51,95％CI [0.34,0.78],P=0.002)、长时间随访生存情况(HR=0.71,95％CI [0.55,0.91],P=0.007)及术后主要不良事件情况(HR=0.63,95％CI [0.50,0.80],P=0.0002)均显著优于置换组,再手术率(HR=2.03,95％CI [1.71,2.41],P＜0.00001)显著高于置换组.结论 二尖瓣成形术在近远期生存率与瓣膜相关并发症方面优于二尖瓣置换术,虽然有着较高的再手术风险,笔者仍建议风湿性心脏瓣膜病患者在技术可行的情况下尝试二尖瓣成形术.%Objective To evaluate the suitability of mitral valve repair (MVP) and mitral valve replacement (MVR) for treating rheumatic heart disease (RHD),in order to provide a guideline for clinical treatment.Methods The Cochrane Library,PubMed,EMbase,CBM,CNKI,VIP,and Wanfang databases had been searched from establishment of the data bases to February 2017 for all clinical trials comparing the outcomes of MVP and MVR for RHD.After being organized and evaluated,data were analyzed by using RevMan 5.3 statistical software.The 30-day mortality rate,long-term survival,reoperation rates and postoperative complications were evaluated by performing a Meta-analysis.Results There were 11 retrospective studies including 4287 patients (1465 MVP cases and 2822 MVR cases).The results of Meta-analysis,which showed that MVP had improved 30 day mortality (OR=0.51,95％CI [0.34,0.78],P=0.002),increased longterm survival (HR=0.71,95％CI [0.55,0.91],P=0.007),and reduced postoperative complications (HR=0.63,95％CI [0.50,0.80],P=0.0002).However,MVP had a significantly higher rate of reoperation (HR=2.03,95％CI [1.71,2.41],P ＜ 0.00001).Conclusion MVP is superior to MVR for short-term and long-term survival and valve-related complications.It has higher possibility for MVP patients received to suffer from reoperation,but authors still recommend that RHD patients should be considered for MVP if it is technically feasible.