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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Abstract Full text Figures/Tables Video References Cited by

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.	吳延虎, 劉翔, 朱錦富, 等. 完全胸腔鏡下手術治療先天性房間隔缺損的臨床效果. 江蘇醫藥, 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, 喬衍禮, 鄭善光, 等. 成人房間隔缺損三種不同手術方式臨床對比分析. 心肺血管病雜志, 2012,31(4): 370-372.
5.	劉錦屏, 王其遜, 薛昊, 等. 全胸腔鏡先天性心臟病房間隔缺損修補術與常規手術的比較. 中國醫學創新, 2014, 11(25): 117-119.
6.	盧華偉. 電視胸腔鏡輔助小切口與常規胸骨正中切口行房間隔缺損修補術臨床對比研究. 福州: 福建醫科大學, 2012.
7.	吳帆, 高峰, 周凱, 等. 全胸腔鏡與正中開胸房間隔缺損修補術臨床對比研究. 西南軍醫, 2015, 22(2): 121-123.
8.	張曉慎, 郭惠明, 劉菁, 等. 完全胸腔鏡下與胸骨切口直視房間隔缺損修補術的臨床比較. 中華胸心血管外科雜志, 2014, 30(3): 152-155.
9.	李傳文, 李平萍, 李憲卿, 等. 完全性胸腔鏡手術與開胸手術行房間隔缺損修補術療效比較. 山東醫藥, 2015,14(42): 38-39.
10.	李杰, 魏廷舉, 張新. 胸腔鏡下房間隔缺損修補術的臨床效果分析. 河南醫學研究, 2015, 24(4): 29-30.
11.	鐘齊慶, 杜正隆, 凌毅. 胸腔鏡與傳統開胸心臟跳動下房間隔缺損修補的臨床效果比較. 中國臨床新醫學, 2013, 14(11): 1039-1041.
12.	陳海宇, 翁國星, 陳智群, 等. 電視胸腔鏡輔助下房間隔缺損修補與常規手術比較研究. 福建醫藥雜志, 2010,15(3): 1-2.
13.	馬麗娟, 李野, 陳厚坤. 三種手術人徑治療房間隔缺損的體外循環對比研究. 中國體外循環雜志, 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.	徐學增, 俞世強, 劉金成, 等. 全胸腔鏡與經胸封堵治療小兒房間隔缺損的對比研究. 中國胸心血管外科臨床雜志, 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.	羅國華, 許建屏, 王宗社, 等. 房間隔缺損封堵術后并發癥的外科治療. 實用臨床醫藥雜志, 2010, 14(5): 62-63.
18.	王躍軍, 程云閣, 鄧海青, 等. 胸腔鏡房間隔缺損修補術初步經驗. 中國臨床醫學, 2006, 13(5): 743-744.
19.	吳延虎, 張石江. 完全胸腔鏡手術治療房間隔缺損. 腹腔鏡外科雜志, 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.	陳海生, 程云閣, 謝翠賢, 等. 胸腔鏡下二尖瓣置換手術的體外循環管理(附45例報告). 中國內鏡雜志, 2005, 11(12): 1339-1340.
22.	徐學增, 石廣永, 陳亞武, 等. 全胸腔鏡下先天性心臟病手術1281例. 中華胸心血管外科雜志, 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.	李東韜, 俞世強, 徐學增, 等. 房間隔缺損全胸腔鏡下修補和常規修補手術對比觀察. 心臟雜志, 2007, 19(2): 215-217.

1. 吳延虎, 劉翔, 朱錦富, 等. 完全胸腔鏡下手術治療先天性房間隔缺損的臨床效果. 江蘇醫藥, 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, 喬衍禮, 鄭善光, 等. 成人房間隔缺損三種不同手術方式臨床對比分析. 心肺血管病雜志, 2012,31(4): 370-372.
5. 劉錦屏, 王其遜, 薛昊, 等. 全胸腔鏡先天性心臟病房間隔缺損修補術與常規手術的比較. 中國醫學創新, 2014, 11(25): 117-119.
6. 盧華偉. 電視胸腔鏡輔助小切口與常規胸骨正中切口行房間隔缺損修補術臨床對比研究. 福州: 福建醫科大學, 2012.
7. 吳帆, 高峰, 周凱, 等. 全胸腔鏡與正中開胸房間隔缺損修補術臨床對比研究. 西南軍醫, 2015, 22(2): 121-123.
8. 張曉慎, 郭惠明, 劉菁, 等. 完全胸腔鏡下與胸骨切口直視房間隔缺損修補術的臨床比較. 中華胸心血管外科雜志, 2014, 30(3): 152-155.
9. 李傳文, 李平萍, 李憲卿, 等. 完全性胸腔鏡手術與開胸手術行房間隔缺損修補術療效比較. 山東醫藥, 2015,14(42): 38-39.
10. 李杰, 魏廷舉, 張新. 胸腔鏡下房間隔缺損修補術的臨床效果分析. 河南醫學研究, 2015, 24(4): 29-30.
11. 鐘齊慶, 杜正隆, 凌毅. 胸腔鏡與傳統開胸心臟跳動下房間隔缺損修補的臨床效果比較. 中國臨床新醫學, 2013, 14(11): 1039-1041.
12. 陳海宇, 翁國星, 陳智群, 等. 電視胸腔鏡輔助下房間隔缺損修補與常規手術比較研究. 福建醫藥雜志, 2010,15(3): 1-2.
13. 馬麗娟, 李野, 陳厚坤. 三種手術人徑治療房間隔缺損的體外循環對比研究. 中國體外循環雜志, 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. 徐學增, 俞世強, 劉金成, 等. 全胸腔鏡與經胸封堵治療小兒房間隔缺損的對比研究. 中國胸心血管外科臨床雜志, 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. 羅國華, 許建屏, 王宗社, 等. 房間隔缺損封堵術后并發癥的外科治療. 實用臨床醫藥雜志, 2010, 14(5): 62-63.
18. 王躍軍, 程云閣, 鄧海青, 等. 胸腔鏡房間隔缺損修補術初步經驗. 中國臨床醫學, 2006, 13(5): 743-744.
19. 吳延虎, 張石江. 完全胸腔鏡手術治療房間隔缺損. 腹腔鏡外科雜志, 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. 陳海生, 程云閣, 謝翠賢, 等. 胸腔鏡下二尖瓣置換手術的體外循環管理(附45例報告). 中國內鏡雜志, 2005, 11(12): 1339-1340.
22. 徐學增, 石廣永, 陳亞武, 等. 全胸腔鏡下先天性心臟病手術1281例. 中華胸心血管外科雜志, 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. 李東韜, 俞世強, 徐學增, 等. 房間隔缺損全胸腔鏡下修補和常規修補手術對比觀察. 心臟雜志, 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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