经导管介入封堵与经胸微创封堵治疗房间隔缺损手术效果的Meta分析

王迪; 赵鹏程; 龚青云; 张成; 李春雨; 毕超; 徐瑞; 李宝全; 张劲松; 陈彦

doi:10.13201/j.issn.1001-1439.2020.11.011

经导管介入封堵与经胸微创封堵治疗房间隔缺损手术效果的Meta分析

- 1 南京医科大学第一附属医院急诊中心(南京, 210029);
- 2 南京医科大学第一附属医院门诊部;
- 3 南京医科大学第一附属医院妇幼分院科技处;
- 4 南京医科大学第一附属医院妇幼分院重症医学科;
- 5 南京医科大学健康江苏研究院
基金项目:
江苏省医院协会医院管理创新研究课题(No:JSYGY-2-2019-150)

江苏省医学重点人才项目(No:ZDRCA2016016)

江苏省妇幼保健协会科研项目(No:FYX201915)

详细信息

通讯作者: 陈彦,E-mail:chenyandoc@163.com

中图分类号: R541.1

收稿日期: 2020-07-09

Meta analysis of transcatheter closure versus minimally invasive transthoracic closure for atrial septal defect: a meta-analysis

- 1 Emergency Center;
- 2 Outpatient Department;
- 3 Department of Science and Technology, Maternity and Child Branch;
- 4 Department of Critical Care Medicine, Maternity and Child Branch, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China;
- 5 Jiangsu Institute of Health, Nanjing Medical University

More Information

Corresponding author: CHEN Yan, E-mail: chenyandoc@163.com

Received Date: 09 July 2020

摘要

摘要: 目的:对比导管介入封堵与胸部微创封堵治疗房间隔缺损在手术效果方面的差异。方法:通过计算机检索中国知网、万方、维普、PubMed、Embase和The Cochrane Library等数据库,搜索关于导管介入封堵与经胸小切口外科手术封堵和机器人技术经胸微创封堵治疗房间隔缺损的手术效果的研究文献,检索时限为2000年1月—2020年7月。应用RevMan 5.3软件进行Meta分析。结果:共纳入13个研究3603例患者,Meta分析结果显示,经导管介入封堵组治疗房间隔缺损对比胸部微创组手术封堵成功率(OR=0.30,95%CI:0.14~0.62,P＜0.05)、ICU停留时间(MD=-6.49,95%CI:-7.27~-5.72,P＜0.05)、术后心房颤动(房颤)发生率(OR=2.80,95%CI:1.26~6.18,P＜0.05)、围术期并发症发生率(OR=0.39,95%CI:0.21~0.74,P＜0.05)、手术时间(MD=-11.27,95%CI:-13.62~-8.92,P＜0.05)和住院时间(MD=-2.03,95%CI:-2.49~-1.56,P＜0.05)有明显差异。两组的残余分流发生率(OR=1.57,95%CI:0.95~2.61,P＞0.05)和术后心律失常发生率(OR=0.21,95%CI:0.02~1.76,P＞0.05)无明显差异。结论:经导管介入封堵手术切口小且美观,围术期并发症发生率小,手术时间、ICU停留时间及住院时间短,对患者创伤小,且术后恢复快。胸部微创手术封堵成功率稍大,适应证较广泛,术后房颤发生较少。经导管介入封堵和胸部微创手术在残余分流发生率、术后心律失常发生率上无统计学差异。
- 房间隔缺损 /
- 介入封堵 /
- 胸部微创封堵 /
- Meta分析
Abstract: Objective: To compare the effect of transcatheter closure and minimally invasive closure in the treatment of atrial septal defect(ASD) by meta analysis. Method: The databases of CNKI, VIP, Wanfang, PubMed, the Cochrane Library and EmBASE were searched by computer. The retrieval time was from January 2000 to July 2020. Result: A total of 13 studies involving 3603 patients were included. The results of meta-analysis showed that there were significant differences in the success rate of transcatheter closure(OR=0.30, 95%CI: 0.14-0.62, P＜0.05), ICU stay time(MD=-6.49, 95%CI:-7.27--5.72, P＜0.05), postoperative atrial fibrillation(OR=2.80, 95%CI: 1.26-6.18, P＜0.05), perioperative complications(OR=0.39, 95%CI: 0.21-0.74, P＜0.05), operation time(MD=-11.27, 95%CI:-13.62--8.92, P＜0.05), hospitalization time(MD=-2.03, 95%CI:-2.49--1.56, P＜0.05) between the two groups. There was no singnificant difference in the incidence of residual shunt incidence(OR=1.57, 95%CI: 0.95-2.61, P＞0.05) and postoperative arrhythmia(OR=0.21, 95%CI: 0.02-1.76, P＞0.05).Conclusion: In catheter group, transcatheter closure of the incision is small and beautiful, the incidence of perioperative complications is less, operation time, ICU stay time and hospital stay time are short, the trauma to patients is small, and the postoperative recovery is fast. In the minimally invasive thoracic surgery group, the success rate of occlusion is slightly higher, the indications are more extensive, and the incidence of postoperative atrial fibrillation was less. There was no significant difference in the incidence of residual shunt and postoperative arrhythmia between the catheter group and the minimally invasive thoracic group.
- atrial septal defect /
- interventional closure /
- minimally invasive thoracic closure /
- Meta analysis

HTML全文

参考文献(21)

[1]	Geva T,Martins JD,Wald RM.Atrial septal defects[J].Lancet,2014,383(9932):1921-1932.
[2]	Bernier PL,Stefanescu A,Samoukovic G,et al.The challenge of congenital heart disease worldwide:epidemiologic and demographic facts[J].Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2010,13(1):26-34.
[3]	Celermajer DS.Atrial septal defects:even simple congenital heart diseases can be complicated[J].Eur Heart J,2018,39(12):999-1001.
[4]	Lewis FJ,Taufic M.Closure of atrial septal defects with the aid of hypothermia;experimental accomplishments and the report of one successful case[J].Surgery,1953,33(1):52-59.
[5]	King TD,Thompson SL,Steiner C,et al.Secundum atrial septal defect.Nonoperative closure during cardiac catheterization[J].JAMA,1976,235(23):2506-2509.
[6]	Honěk T,Spatenka J,Hájek T,et al.[Minithoracotomy in cardiac surgery.Initial experience with closure of an atrial septal defect with a minithoracotomy][J].Rozhl Chir,1996,75(6):286-289.
[7]	Bakar SN,Burns D,Diamantouros P,et al.Clinical outcomes of a combined transcatheter and minimally invasive atrial septal defect repair program using a'Heart Team'approach[J].J Cardiothorac Surg,2018,13(1):11-12.
[8]	Zhu P.Clinical evaluation of percutaneous and intraoperative device closure of atrial septal defects under transesophageal echocardiographic guidance:one center experience and mid-term follow-up[J].J Cardiothorac Surg,2020,15(1):20-21.
[9]	Kadirogullari E,Onan B,Timur B,et al.Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure:A single-center experience[J].JCard Surg,2020,35(4):764-771.
[10]	Kodaira M,Kawamura A,Okamoto K,et al.Comparison of clinical outcomes after transcatheter vs.minimally invasive cardiac surgery closure for atrial septal defect[J].Circ J,2017,81(4):543-551.
[11]	Schneeberger Y,Schaefer A,Conradi L,et al.Minimally invasive endoscopic surgery versus catheterbased device occlusion for atrial septal defects in adults:reconsideration of the standard of care[J].Interact Cardiovasc Thorac Surg,2017,24(4):603-608.
[12]	Guo JJ.Long-term outcomes of device closure of very large secundum atrial septal defects:a comparison of transcatheter vs intraoperative approaches[J].Clin Cardiol,2012.35(10):626-631.
[13]	Mishra S,Tomar M,Malhotra R,et al.Comparison between transcatheter closure and minimally invasive surgery for fossa ovalis atrial septal defect:a single institutional experience[J].Indian Heart J,2008,60(2):125-132.
[14]	张欢,周小燕,张露丹.心导管介入封堵术与经胸小切口术治疗房间隔缺损合并肺动脉高压患者的安全性及疗效比较[J].湖南师范大学学报(医学版),2019,16(2):45-47.
[15]	汪成,杨明,肖苍松,等.成人继发孔型房间隔缺损机器人微创外科修补术和经导管介入封堵术的临床对比研究[J].解放军医学杂志,2016,41(5):407-411.
[16]	卢中,申运华,严中亚,等.经胸小切口封堵与经皮介入封堵术治疗房间隔缺损的比较[J].山东大学学报(医学版),2016,20(2):49-52.
[17]	郭晓博,李红昕,郭文彬,等.单纯超声引导下经皮与经胸房间隔缺损封堵术的疗效[J].中华胸心血管外科杂志,2014,30(8):463-466.
[18]	张潭,张晶,马小静,等.超声心动图监护下心导管介入与经胸小切口手术治疗小儿房间隔缺损的比较[J].临床心血管病杂志,2012,28(12):904-906.
[19]	易岂建,李谧,吕铁伟,等.经导管封堵器与心脏直视手术治疗房间隔缺损疗效对比分析[J].中国实用儿科杂志,2008,23(6):450-451.
[20]	梁涛.脂蛋白相关磷脂酶A2在急性冠脉综合征中的临床价值[J].临床血液学杂志,2018,31(10):733-738.
[21]	黄青霞.经导管三尖瓣关闭不全介入治疗的现状及展望[J].临床心血管病杂志,2020,325(7):594-599.