2019 年第 9 期 第 14 卷

应用三尖瓣切开技术治疗室间隔缺损的Meta分析

Tricuspid valve detachment as approach to ventricular septal defect repair: a meta-analysis

作者：季巍莫莹朱耀斌罗毅

英文作者：

单位：100020北京，首都儿科研究所附属儿童医院心脏外科（季巍、罗毅）；100029首都医科大学附属北京安贞医院小儿心脏中心（莫莹）；100045首都医科大学附属北京儿童医院小儿心脏外科（朱耀斌）

英文单位：

关键词：室间隔缺损；三尖瓣切开；Meta分析

英文关键词：

• 摘要：

• 【摘要】目的    系统评价三尖瓣切开(TVD)技术与不切开三尖瓣(non-TVD)两种术式治疗室间隔缺损的疗效和安全性。方法    检索1962年2月至2018年2月在PubMed、EMbase、The Cochrane Library、中国知网、中国生物医学文献数据库和万方数据库发表的关于室间隔缺损修补术中应用TVD与non-TVD技术的临床研究，主要观察指标包括体外循环时间、主动脉阻断时间，术后并发症包括残余分流、完全性房室传导阻滞、中重度三尖瓣反流。结果    最终纳入9篇非随机对照研究，共4 144例患儿，其中TVD组1 358例，non-TVD组2 786例，膜周部VSD 3 963例，其他类型VSD 181例。Meta分析结果显示，TVD组主动脉阻断时间明显长于non-TVD组（均数差=5.01, 95%置信区间：2.38~7.64,P=0.000 2），但2组间体外循环时间、残余分流、完全性房室传导阻滞、中重度三尖瓣反流发生率比较差异均无统计学意义（均P>0.05）。结论    TVD技术未延长手术时间，且不增加术后并发症发生率。

• 【Abstract】Objective    To systematically review the efficacy and safety of tricuspid valve detachment(TVD) versus conventional surgical repair(non-TVD) in the treatment of ventricular septal defect(VSD). Methods    Literatures about VSD repair with TVD and non-TVD published between February 1962 and February 2018 were identified using PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Database and Wanfang Data. Cardiopulmonary bypass time, aortic cross-clamping time, postoperative complications including residual defect, complete atrioventricular block and moderate to severe tricuspid regurgitation were analyzed. Results    Nine studies involving 4 144 patients in total, 1 358 TVD and 2 786 non-TVD, 3 963 perimembranous TSD and 181 other types, met the inclusion criteria. Meta analysis demonstrated longer aortic cross-clamping time in TVD patients compared to that in non-TVD patients(mean difference=5.01, 95% confidence interval: 2.38-7.64, P=0.000 2); no significant differences were observed in cardiopulmonary bypass time, incidences of residual defect, complete atrioventricular block and moderate to severe tricuspid regurgitation(all P>0.05). Conclusion    TVD provides equally viable and safe alternative in treating VSD.