经介入治疗和手术修补房间隔缺损有效性和安全性的系统评价

Efficacy and safety of the interventional therapy and surgical repair for atrial septal defects: a systematic review

摘要:

目的：采用系统评价方法评估国内经手术修补和介入治疗房间隔缺损（atrial septal defect，ASD）的有效性和安全性，为临床治疗提供一定参考。方法：制定检索策略，对中国生物医学数据库、中国知网、万方、维普等数据库进行检索，全面检索关于房间隔缺损经介入治疗和手术修补对照研究的临床试验，并对文献进行筛选、资料提取和质量评价。采用 RevMan5.2软件进行数据处理。结果：13篇文献纳入Meta分析，均为非随机对照试验，介入组 984例，治疗组 890例。结果显示，介入组的成功率低于手术组（13项对照研究，96.65% vs. 99.66%，RR=0.97，95%CI=0.96～0.98，P=0.000），术后并发症发生率低于手术组（12项对照研究，6.07% vs. 20.26%，RR=0.29，95%CI=0.22～0.39，P=0.000），术后残余分流发生率高于手术组（10项对照研究，2.31% vs. 1.70%，RR=1.45，95%CI=0.75～2.82，P=0.270）。结论：介入治疗的术后并发症低于手术组，具有创伤小、安全性高、术后恢复快等优点，在适应证范围内，介入治疗可作为外科手术治疗的替代疗法。

Abstract:

Objective：To evaluate the efficiency and safety of transcatheter closure and surgical repair for atrial septal defect（ASD） using systematic review method and to provide references for clinical treatment. Methods：The CBM，CNKI，WanFang Med Online and VIP were searched for all controlled trials. Screening，quality evaluation and information extraction were carried out on the studies according to including and excluding standard. The software RevMan 5.2 was used for data analysis. Results：Thirteen included studies were not randomized controlled trials，984 cases in intervention group and 890 cases in surgery group. The combined results showed that the procedural success rate of transcatheter closure group was lower than that of surgery group（13 controlled trails，96.64% vs. 99.66%，RR=0.97，95%CI=0.96 to 0.98，P=0.000）. Although the instant residual shunt rate was higher in transcatheter closure group than in surgery group（10 controlled trails，2.31% vs. 1.70%，RR=1.45，95%CI=0.75 to 2.82，P=0.270），the total complication rate was lower in transcatheter closure group than that in surgery group（12 controlled trails，6.07% vs. 20.26%，RR=0.29，95%CI=0.22 to 0.39，P=0.000）. Conclusion：Transcatheter closure of patent ductus arteriosus is an ideal procedure within acceptable limits owing to its reliability，safety，min-invasiveness and short hospitalization.