摘要
目的室间隔缺损(VSD)是先天性心脏病中最常见的类型,目前其根治方法有经导管堵闭和外科手术修补。采用Meta分析方法评估中国大陆经导管堵闭和外科手术修补VSD对照研究的疗效和安全性,为临床优化治疗提供一定的参考依据。方法通过检索中、外文数据库,全面收集中国大陆经导管堵闭与外科手术治疗VSD的文献。制定文献的纳入及排除标准,由2名研究者分别独立筛选文献,符合纳入标准的文献按Shekelle等建议的标准进行文献质量评估。对患者的年龄、体重、VSD大小和住院天数等进行分析比较;对手术成功率、残余分流发生率和并发症发生率等应用RevMan4.28软件进行Meta分析。结果7篇文献纳入分析,均为单中心的非随机对照研究(Ⅱa级)。经导管堵闭组和外科手术组年龄差异无统计学意义,经导管堵闭组患者的体重较重,治疗的VSD直径较小。Meta分析结果显示:经导管堵闭组的成功率低于外科手术组(97.6%vs99.2%,P=0.007);两组病死率差异无统计学意义(0vs1.4%,P=0.51);两组残余分流发生率差异无统计学意义(2.5%vs3.2%,P=0.91);经导管堵闭组的并发症发生率低于外科手术组(10.1%vs25.7%,P<0.00001);两组心律失常发生率差异无统计学意义(5.5%vs6.6%,P=0.61);经导管堵闭组的术后感染发生率低于外科手术组(0vs7.6%,P=0.002)。结论经导管堵闭VSD具有创伤小、安全性高和术后恢复快等优点,但治疗有选择性,长期疗效需进一步随访。对具有适应证的VSD患者,可优先考虑经导管堵闭治疗。
Objective Ventricular septal defect is the most common congenital heart disease. Transcatheter closure and surgical repair are the radical cure. Studies on ventricular septal defects treated by transcatheter closure versus surgery were summarized. Through a Meta analytic review, the effectiveness and safety of two procedures were discussed. Then suitable treatment would be selected partly based on this study. Methods The articles about ventricular septal defect treated by transcatheter closure and surgical repair were selected through searching medical databases. According to including and excluding criteria, articles were searched through medical databases from Jan., 2002 to Dec., 2006 without language restriction as follows： Chinese Medical Current Contents（CMCC）, Database of Chinese Scientific and Technical Periodicals, Chinese Conference Papers Darabase, Pubmed Database, OVID Database and EBSCO Database. The articles were searched through the key words in Chinese and English, they were ventricular septal defect, transcatheter closure, surgical repair. After two evaluators abstraction data including basal information, intervention measures and clinical prognosis were finally agreed with other three evaluators. According to including and excluding criteria, articles were evaluated （ Shekelle PG, et al）. The age, weight, defect size, and hospitalization days were analysed statistially; the success rate, residual shunt rate and complication rate were analyzed by RevMan 4.28. Results There were seven papers corresponding to criteria. All of them did not apply random control study（ IIa）. The age was similar in two groups, but the VSD size in transcatheter group were lower than surgical group, the weight in transeatheter group were higher than surgical group. The success rate in transcatheter group（97.8%） was lower than surgical group（99.2%）, P = 0. 007. The mortality was similar in two groups（0 vs 1.4%, P = 0.51）. Residual shunt rate was similar in two groups（ 2. 5% VS 3. 2%, P = 0.91）. Complication rate in transcatheter group（ 10.1% ） was lower than surgical group（ 25.7% ）. P 〈0. 000 01. Arrhythmia rate was similar in two groups（ 5.48% vs 6.64%, P = 0.61）. Postoperation infection rate in transcatheter group（0） was lower than surgical group（7.65% ）, P = 0. 002. Conclusions Transcatheter closure has the advantages of less vulnerarble, recovering faster and safe. But it is selective and the further outcome needs to be followed up. If the patient with ventricular septal defect is suitable, transcatheter closure will be the first choice.
出处
《中国循证儿科杂志》
CSCD
2008年第1期15-20,共6页
Chinese Journal of Evidence Based Pediatrics
关键词
室间隔缺损
导管堵闭术
外科手术
META分析
Ventricular septal defect
Trancatheter closure
Surgical repair
Meta analysis
作者简介
通讯作者 韩勇，E-mail：hanyongl98206@yahoo．com．cn
