采用Meta分析探讨完全性肺静脉异位连接(TAPVC)手术修复术后肺静脉阻塞(PVO)的危险因素。
数据库,包括PubMed,Embase,系统地搜索了WebofScience和Cochrane图书馆。目的探讨TAPVC术后发生PVO的危险因素。出版物由2位作者独立筛选纳入标准,方法学质量评价和数据提取。获得了纽卡斯尔-渥太华量表和医疗保健研究和质量检查表来评估研究的质量。根据异质性检验,采用随机效应模型或固定效应模型对数据进行汇总。
共有16项研究(2,385名参与者)纳入荟萃分析。所有纳入的研究均为回顾性研究。汇总了六个潜在的风险因素,其中5例与术后PVO显著相关。术前有PVO的患者更容易发生术后PVO[比值比(OR)=5.27,95%置信区间(CI)=(2.75,10.11),P<0.01]。与无步骤程序相比,传统手术方式与术后PVO相关[OR=1.80,95%CI=(1.20,2.71),P<0.01]。混合型TAPVC在术后PVO中起关键作用[OR=3.78,95%CI=(1.08,13.18),P=0.04]。逆方差分析显示体外循环时间较长[危险比(HR)=1.01,95%CI=(1.01,1.02),P<0.00001]和主动脉阻断时间[HR=1.01,95%CI=(1.01,1.02),P<0.01]与术后PVO显著相关。异位症[OR=1.18,95%CI=0.13,10.45,P=0.88]作为术后PVO的危险因素无统计学意义。
这项荟萃分析可能为TAPVC术后PVO的危险因素提供了一个视角,因此,我们的发现导致更多的研究预测TAPVC术后PVO。
A meta-analysis was performed to investigate the risk factors for postoperative pulmonary venous obstruction (PVO) after surgical repair of total anomalous pulmonary venous connection (TAPVC).
Data bases including PubMed, Embase, Web of Science and Cochrane Library were searched systematically. The goal was to discuss the risk factors for postoperative PVO after TAPVC. Publications were screened by 2 authors independently for criteria inclusion, methodological quality assessment and data extraction. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist were obtained to assess the quality of the studies. Data were pooled by the random effect model or the fixed effect model according to the heterogeneity test.
A total of 16 studies (2,385 participants) were included in the meta-analysis. All included studies were retrospective studies. Six potential risk factors were pooled, 5 of which were significantly associated with postoperative PVO. Patients with preoperative PVO were more likely to suffer from postoperative PVO [odds ratio (OR)=5.27, 95% confidence interval (CI) = (2.75, 10.11), P < 0.01]. Compared with a sutureless procedure, the conventional operative procedure was associated with postoperative PVO [OR = 1.80, 95% CI=(1.20, 2.71), P < 0.01]. A mixed type TAPVC plays a critical role in postoperative PVO [OR = 3.78, 95% CI=(1.08, 13.18), P = 0.04]. Inverse variance analysis showed that longer cardiopulmonary bypass time [hazard ratio (HR)=1.01, 95% CI=(1.01, 1.02), P < 0.00001] and aortic cross-clamp time [HR = 1.01, 95% CI=(1.01, 1.02), P < 0.01] were significantly associated with postoperative PVO. Heterotaxy [OR = 1.18, 95% CI = 0.13, 10.45, P = 0.88] was not statistically significant as a risk factor for postoperative PVO.
This meta-analysis may provide a perspective on the risk factors for postoperative PVO after TAPVC, thus leading to more studies predicting postoperative PVO after TAPVC with our findings.