Lin Zhiyong, Ge Hanwei, Xue Jiyang, Wu Guowei, Du Jie, Hu Xingti, Zhao Qifeng
The Children's Department of Cardiovascular and Thoracic Surgery, Children's Heart Center, the Second Affiliated Hospital & Yuying Children's Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, P.R. China.
Congenit Heart Dis. 2017 Dec;12(6):711-720. doi: 10.1111/chd.12503. Epub 2017 Aug 28.
This study aims to assess and compare the early and long-term effects of extracardiac conduit (EC) and lateral tunnel (LT) in patients with a functional single ventricle through meta-analysis.
A systematic search was performed in PubMed, Embase, Cochrane Library, CNKI, VIP, CBM, and WanFang databases for papers that were published until August 1, 2016. Cochrane systematic review method was used for paper screening and information retrieve, and RevMan 5.3 software was applied for the meta-analysis.
Data for 10 studies with a total of 3814 patients were retrieved. The advantages of EC comparing to LT include: lower 30 day postsurgery supraventricular arrhythmia incidence (Relative Risk [RR] = 0.31 [0.17, 0.55], P < .001), lower protein loss enteropathy incidence (RR = 0.33 [0.11, 0.96], P = .04), and requiring no cardiopulmonary bypass. However, the chest drainage time was longer (mean difference [MD] = 1.99 [1.83, 2.15], P < .001) in EC. There were no significant differences in early postoperative mortality, long-term mortality, long-term arrhythmia, Fontan takedown, ventilator-assisted ventilation, ICU stay, thrombosis, pleural effusion, and pericardial effusion between EC and LT.
EC had a lower incidence of supraventricular arrhythmia (30 days after operation) and the rate of protein losing enteropathy than LT, and requiring no cardiopulmonary bypass. These show that EC has an advantage over the LT in patients with a functional single ventricle.
本研究旨在通过荟萃分析评估和比较心外管道（EC）和侧隧道（LT）对功能性单心室患者的早期和长期影响。
在PubMed、Embase、Cochrane图书馆、中国知网、维普、中国生物医学文献数据库和万方数据库中进行系统检索，纳入截至2016年8月1日发表的论文。采用Cochrane系统评价方法进行文献筛选和信息提取，并应用RevMan 5.3软件进行荟萃分析。
检索到10项研究的数据，共3814例患者。与LT相比，EC的优势包括：术后30天室上性心律失常发生率较低（相对危险度[RR]=0.31[0.17,0.55]，P<0.001），蛋白丢失性肠病发生率较低（RR=0.33[0.11,0.96]，P=0.04），且无需体外循环。然而，EC的胸腔引流时间较长（平均差值[MD]=1.99[1.83,2.15]，P<0.001）。EC和LT在术后早期死亡率、长期死亡率、长期心律失常、Fontan手术拆除、呼吸机辅助通气、ICU住院时间、血栓形成、胸腔积液和心包积液方面无显著差异。
EC术后30天室上性心律失常发生率和蛋白丢失性肠病发生率低于LT，且无需体外循环。这些表明，在功能性单心室患者中，EC比LT具有优势。
