Efficacy of Totally Thorascopic and Median Sternotomy Approaches for Atrial Septal Defect Repair: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ABUDOUWAILI , LIJun-hong , MuLa-Ti ,  ABUDUNAIBI

Department of Cardiac Surgery Division One, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

ABUDUNAIBI, Email: nebi-boss@hotmail.com

Keywords：

Atrial septal defect; Thoracoscope surgery; Minimally invasive surgery, Cardiac surgery; Systematic review; Meta analysis; Cohort study

DOI：

10.7507/1672-2531.20160178

Video：

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Objective To systematically review the efficacy and safety of totally thorascopic (TT) and median sternotomy (MS) approaches for atrial septal defect repair (ASDR). Methods Databases including The Cochrane Library (Issue 2, 2016), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to June 2016, to collect randomized controlled trials or cohort studies about TT vs. MS approaches for ASDR. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 11 cohort studies involving 687 patients were included with 305 patients in the TT group, and 382 patients in the MS group. The results of meta-analysis showed that: The TT group had shorter postoperative ventilation time (MD=-1.49, 95%CI -2.27 to -0.71, P=0.000 2), postoperative ICU stay time (MD=-7.30, 95%CI -12.07 to -2.53, P=0.003), hospital stay time (MD=-2.06, 95%CI -2.80 to -1.32, P<0.000 01) and less postoperative drainage (MD=-199.83, 95%CI -325.96 to -73.70, P=0.002) than the MS group. But the bypass time (MD=9.42, 95%CI 1.55 to 17.30, P=0.02) and aortic clamping time (MD 6.78, 95%CI 3.48 to 10.07, P<0.000 1) of the TT group were significantly longer than those of the MS group. Conclusion Compared with MS, TT can significantly reduce the length of postoperative ventilation, postoperative ICU stay, hospital stay and postoperative drainage. But there are risks of prolonged bypass time and aortic clamping time in the TT group. Due to the quantity and quality of the included studies, the above conclusions still needs to be verified by carrying out more studies.

Citation： ABUDOUWAILI, LIJun-hong, MuLa-Ti, ABUDUNAIBI. Efficacy of Totally Thorascopic and Median Sternotomy Approaches for Atrial Septal Defect Repair: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(10): 1169-1175. doi: 10.7507/1672-2531.20160178 Copy

1.	吴延虎, 刘翔, 朱锦富, 等. 完全胸腔镜下手术治疗先天性房间隔缺损的临床效果. 江苏医药, 2011, 37(13): 1548-1550.
2.	Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non randomized studies in meta analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm..
3.	Chu MW, Losenno KL, Fox SA, et al. Clinical outcomes of minimally invasive endoscopic and conventional sternotomy approaches for atrial septal defect repair. Can J Surg, 2014, 57(3): E75-E81.
4.	倪良春, 乔衍礼, 郑善光, 等. 成人房间隔缺损三种不同手术方式临床对比分析. 心肺血管病杂志, 2012,31(4): 370-372.
5.	刘锦屏, 王其逊, 薛昊, 等. 全胸腔镜先天性心脏病房间隔缺损修补术与常规手术的比较. 中国医学创新, 2014, 11(25): 117-119.
6.	卢华伟. 电视胸腔镜辅助小切口与常规胸骨正中切口行房间隔缺损修补术临床对比研究. 福州: 福建医科大学, 2012.
7.	吴帆, 高峰, 周凯, 等. 全胸腔镜与正中开胸房间隔缺损修补术临床对比研究. 西南军医, 2015, 22(2): 121-123.
8.	张晓慎, 郭惠明, 刘菁, 等. 完全胸腔镜下与胸骨切口直视房间隔缺损修补术的临床比较. 中华胸心血管外科杂志, 2014, 30(3): 152-155.
9.	李传文, 李平萍, 李宪卿, 等. 完全性胸腔镜手术与开胸手术行房间隔缺损修补术疗效比较. 山东医药, 2015,14(42): 38-39.
10.	李杰, 魏廷举, 张新. 胸腔镜下房间隔缺损修补术的临床效果分析. 河南医学研究, 2015, 24(4): 29-30.
11.	钟齐庆, 杜正隆, 凌毅. 胸腔镜与传统开胸心脏跳动下房间隔缺损修补的临床效果比较. 中国临床新医学, 2013, 14(11): 1039-1041.
12.	陈海宇, 翁国星, 陈智群, 等. 电视胸腔镜辅助下房间隔缺损修补与常规手术比较研究. 福建医药杂志, 2010,15(3): 1-2.
13.	马丽娟, 李野, 陈厚坤. 三种手术人径治疗房间隔缺损的体外循环对比研究. 中国体外循环杂志, 2009, 7(4): 215-217.
14.	Fukunaga N, Yuzaki M, Shomura Y, et al. Clinical outcomes of open heart surgery in patients with atopic dermatitis. Asian Cardiovasc Thorac Ann, 2012, 20(2): 137-140.
15.	徐学增, 俞世强, 刘金成, 等. 全胸腔镜与经胸封堵治疗小儿房间隔缺损的对比研究. 中国胸心血管外科临床杂志, 2007, 14(5): 338-340.
16.	Ma Z S, Dong M F, Yin Q Y, et al. Totally thoracoscopic repair of atrial septal defect without robotic assistance: a single-center experience. J Thorac Cardiovasc Surg, 2011, 141(6): 1380-1383.
17.	罗国华, 许建屏, 王宗社, 等. 房间隔缺损封堵术后并发症的外科治疗. 实用临床医药杂志, 2010, 14(5): 62-63.
18.	王跃军, 程云阁, 邓海青, 等. 胸腔镜房间隔缺损修补术初步经验. 中国临床医学, 2006, 13(5): 743-744.
19.	吴延虎, 张石江. 完全胸腔镜手术治疗房间隔缺损. 腹腔镜外科杂志, 2012, 17(10): 725-727.
20.	Ma ZS, Yin QY, Dong MF, et al. Quality of life in patients undergoing totally thoracoscopic closure for atrial septal defect. Ann Thorac Surg, 2011, 92(6): 2230-2234.
21.	陈海生, 程云阁, 谢翠贤, 等. 胸腔镜下二尖瓣置换手术的体外循环管理(附45例报告). 中国内镜杂志, 2005, 11(12): 1339-1340.
22.	徐学增, 石广永, 陈亚武, 等. 全胸腔镜下先天性心脏病手术1281例. 中华胸心血管外科杂志, 2012, 28(4): 195-197.
23.	Gil-Jaurena J M, Gonzalez-Lopez M T, Perez-Caballero R, et al. [15 years of minimally invasive paediatric cardiac surgery; development and trends]. An Pediatr (Barc), 2016, 84(6): 304-310.
24.	李东韬, 俞世强, 徐学增, 等. 房间隔缺损全胸腔镜下修补和常规修补手术对比观察. 心脏杂志, 2007, 19(2): 215-217.

1. 吴延虎, 刘翔, 朱锦富, 等. 完全胸腔镜下手术治疗先天性房间隔缺损的临床效果. 江苏医药, 2011, 37(13): 1548-1550.
2. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non randomized studies in meta analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm..
3. Chu MW, Losenno KL, Fox SA, et al. Clinical outcomes of minimally invasive endoscopic and conventional sternotomy approaches for atrial septal defect repair. Can J Surg, 2014, 57(3): E75-E81.
4. 倪良春, 乔衍礼, 郑善光, 等. 成人房间隔缺损三种不同手术方式临床对比分析. 心肺血管病杂志, 2012,31(4): 370-372.
5. 刘锦屏, 王其逊, 薛昊, 等. 全胸腔镜先天性心脏病房间隔缺损修补术与常规手术的比较. 中国医学创新, 2014, 11(25): 117-119.
6. 卢华伟. 电视胸腔镜辅助小切口与常规胸骨正中切口行房间隔缺损修补术临床对比研究. 福州: 福建医科大学, 2012.
7. 吴帆, 高峰, 周凯, 等. 全胸腔镜与正中开胸房间隔缺损修补术临床对比研究. 西南军医, 2015, 22(2): 121-123.
8. 张晓慎, 郭惠明, 刘菁, 等. 完全胸腔镜下与胸骨切口直视房间隔缺损修补术的临床比较. 中华胸心血管外科杂志, 2014, 30(3): 152-155.
9. 李传文, 李平萍, 李宪卿, 等. 完全性胸腔镜手术与开胸手术行房间隔缺损修补术疗效比较. 山东医药, 2015,14(42): 38-39.
10. 李杰, 魏廷举, 张新. 胸腔镜下房间隔缺损修补术的临床效果分析. 河南医学研究, 2015, 24(4): 29-30.
11. 钟齐庆, 杜正隆, 凌毅. 胸腔镜与传统开胸心脏跳动下房间隔缺损修补的临床效果比较. 中国临床新医学, 2013, 14(11): 1039-1041.
12. 陈海宇, 翁国星, 陈智群, 等. 电视胸腔镜辅助下房间隔缺损修补与常规手术比较研究. 福建医药杂志, 2010,15(3): 1-2.
13. 马丽娟, 李野, 陈厚坤. 三种手术人径治疗房间隔缺损的体外循环对比研究. 中国体外循环杂志, 2009, 7(4): 215-217.
14. Fukunaga N, Yuzaki M, Shomura Y, et al. Clinical outcomes of open heart surgery in patients with atopic dermatitis. Asian Cardiovasc Thorac Ann, 2012, 20(2): 137-140.
15. 徐学增, 俞世强, 刘金成, 等. 全胸腔镜与经胸封堵治疗小儿房间隔缺损的对比研究. 中国胸心血管外科临床杂志, 2007, 14(5): 338-340.
16. Ma Z S, Dong M F, Yin Q Y, et al. Totally thoracoscopic repair of atrial septal defect without robotic assistance: a single-center experience. J Thorac Cardiovasc Surg, 2011, 141(6): 1380-1383.
17. 罗国华, 许建屏, 王宗社, 等. 房间隔缺损封堵术后并发症的外科治疗. 实用临床医药杂志, 2010, 14(5): 62-63.
18. 王跃军, 程云阁, 邓海青, 等. 胸腔镜房间隔缺损修补术初步经验. 中国临床医学, 2006, 13(5): 743-744.
19. 吴延虎, 张石江. 完全胸腔镜手术治疗房间隔缺损. 腹腔镜外科杂志, 2012, 17(10): 725-727.
20. Ma ZS, Yin QY, Dong MF, et al. Quality of life in patients undergoing totally thoracoscopic closure for atrial septal defect. Ann Thorac Surg, 2011, 92(6): 2230-2234.
21. 陈海生, 程云阁, 谢翠贤, 等. 胸腔镜下二尖瓣置换手术的体外循环管理(附45例报告). 中国内镜杂志, 2005, 11(12): 1339-1340.
22. 徐学增, 石广永, 陈亚武, 等. 全胸腔镜下先天性心脏病手术1281例. 中华胸心血管外科杂志, 2012, 28(4): 195-197.
23. Gil-Jaurena J M, Gonzalez-Lopez M T, Perez-Caballero R, et al. [15 years of minimally invasive paediatric cardiac surgery; development and trends]. An Pediatr (Barc), 2016, 84(6): 304-310.
24. 李东韬, 俞世强, 徐学增, 等. 房间隔缺损全胸腔镜下修补和常规修补手术对比观察. 心脏杂志, 2007, 19(2): 215-217.

Chinese Journal of Evidence-Based Medicine

Efficacy of Totally Thorascopic and Median Sternotomy Approaches for Atrial Septal Defect Repair: A Meta-analysis

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