中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

先天性膜周型室间隔缺损经胸封堵有效性及安全性的系统评价与 Meta 分析

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目的 评估室间隔缺损经胸封堵术的安全性和有效性。 方法 计算机检索 PubMed、The Cochrane Library,EMbase 和中国生物医学文献数据库(CBM),查找建库至 2018 年 10 月室间隔缺损经胸封堵相关文献。膜周型室间隔缺损患者所占比例在 80% 以上的研究被纳入分析。分析结果以汇总的手术成功率及并发症发生率加 95% 置信区间(CI)表达。根据膜周型室间隔缺损占比进行亚组分析。围手术期数据与随访资料的比较结果采用风险差(RD)表示。 结果 纳入 15 篇文献,包括 2 篇随机对照研究、3 篇回顾性队列研究和 10 篇回顾性单臂研究,纳入室间隔缺损患者 4 164 例(膜周型 3 848 例)。封堵术总成功率为 95.4%,术后残余分流、主动脉瓣关闭不全、三尖瓣关闭不全、Ⅲ度房室传导阻滞的发生率分别为 5%、0.1%、3% 及 <0.001%。随访结果显示残余分流和主动脉瓣关闭不全有明显改善。 结论 先天性膜周型室间隔缺损经胸封堵术安全有效。但由于本研究存在局限性,因此结果需要多中心随机对照试验进一步验证。

Objective To investigate the safety and effectiveness of perventricular device closure (PDC) for congenital ventricular septal defects (VSD) by a meta-analysis. Methods PubMed, The Cochrane Library, EMbase and China Biology Medicine (CBM) databases were searched for studies on PDC of VSD up to October 2018 by computer. We included studies only with more than 80% patients diagnosed with perimembranous VSD. A meta-analysis was performed to obtain pooled estimates of success rate and incidences of complications with 95% confidence interval (CI). Subgroup analysis stratified by percentage of perimembranous VSD was performed. Risk difference (RD) was used in the comparison of perioperative data with follow-up data. Results Fifteen studies (2 randomized controlled trials, 3 retrospective cohorts, and other 10 retrospective single-arm studies) involving 4 164 patients (3 848 patients with perimembranous VSD) were included in this meta-analysis. The pooled success rate was 95.4%. Incidences of residual shunt, aortic insufficiency, tricuspid insufficiency, and third-degree atrioventricular block were 5%, 0.1%, 3%, and less than 0.001% respectively. Improvements of residual shunt and aortic insufficiency were confirmed in follow-up patients. Conclusion PDC of congenital perimembranous VSDs is safe and yields good results. Because some limitations can not be overcomed, multicenter randomized controlled trials are needed to confirm our results.

关键词: 室间隔缺损; 膜周型; 经胸封堵; 并发症; Meta 分析

Key words: Ventricular septal defect; perimembranous; perventricular device closure; complications; meta-analysis

引用本文: 李梦思, 李东旭, 殷小容, 安琪. 先天性膜周型室间隔缺损经胸封堵有效性及安全性的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2019, 26(3): 251-259. doi: 10.7507/1007-4848.201811044 复制

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