论文部分内容阅读
目的:通过Meta分析评价完全胸腔手术(totally thoracoscopic surgery,TTS)与常规胸骨正中切口心内直视手术(median sternotomy,MS)两种术式治疗先天性心脏病(congenital heart diseases,CHD)的疗效。方法:计算机检索PubMed、Embase、Cochrane Library(2012年第7期)、VIP、CNKI、CBM和万方数据库,查找所有比较TTS和MS治疗先天性心脏病的随机对照试验(randomized controlled trials,RCT)与临床对照研究(controlled clincal trials,CCT),检索时限均为建库至2012年6月。同时手检纳入文献的参考文献,语种限制为中文和英文。按纳入排除标准由两人独立进行文献的筛选、资料提取和质量评价,最后将提取的资料采用RevMan 5.1软件进行Meta分析。结果:共纳入9个研究,包括3个RCT和6个CCT;共748例患者,其中TTS组364例,MS组384例。Meta分析结果显示:TTS组在呼吸机辅助呼吸时间加权均数差[(WMD)=-1.17,95%CI(-2.15,-0.20),P=0.02]、ICU时间[WMD=-12.22,95%CI(-17.34,-7.10),P<0.01]、胸腔闭式引流量[WMD=-2.36,95%CI(-3.42,-1.18),P<0.01]和住院时间[WMD=-1.92,95%CI(-2.69,-1.16),P<0.01]上都明显低于MS组,而主动脉阻断时间[WMD=5.70,95%CI(1.33,10.07),P=0.01]和CPB时间[WMD=13.08,95%CI(3.48,22.69),P<0.01]长于MS组,但是在手术时间[WMD=0.25,95%CI(-0.18,0.69),P>0.05]和术后并发症[OR=1.21,95%CI(0.50,2.92),P>0.05]两组差异无统计学意义。结论:TTS治疗先天性心脏病安全有效,创伤小,术后恢复快,美容效果好。
Objective: To evaluate the efficacy of total thoracic surgery (TTS) and conventional sternotomy (MS) in the treatment of congenital heart diseases (CHD) by Meta-analysis. . METHODS: All randomized controlled trials (RCTs) comparing TTS and MS in the treatment of congenital heart disease were searched by PubMed, Embase, Cochrane Library (No.7/2012), VIP, CNKI, CBM and Wanfang database. And controlled clinical trials (controlled clincal trials, CCT), the search time limit are building database to June 2012. At the same time hand-checked into the literature reference, the language is limited to Chinese and English. According to inclusion exclusion criteria, the two independent screening, data extraction and quality evaluation, and finally extract the data using RevMan 5.1 software for meta-analysis. Results: A total of 9 studies were included, including 3 RCTs and 6 CCTs; a total of 748 patients, including 364 in the TTS group and 384 in the MS group. The results of Meta-analysis showed that in the TTS group, the weighted mean difference in ventilator-assisted breathing time was (WMD) = -1.17, 95% CI (-2.15, -0.20), P = 0.02; ICU time [WMD = -12.22,95 % CI (-17.34, -7.10), P <0.01], thoracic closed drainage [WMD = -2.36,95% CI -3.42, -1.18, P 0.01 and length of stay [WMD = -1.92, 95% CI (1.33, 10.07), P = 0.01] and CPB time (WMD = 5.70, 95% CI: -2.69, -1.16, P <0.01) (WMD = 13.08,95% CI 3.48,22.69, P <0.01) was longer than that in MS group. However, at WMD = 0.25,95% CI (-0.18,0.69), P> 0.05 and postoperative complications [OR = 1.21, 95% CI (0.50, 2.92), P> 0.05] There was no significant difference between the two groups. Conclusion: TTS treatment of congenital heart disease is safe and effective, small trauma, quick recovery, good cosmetic effect.