类癌心脏病的手术治疗结果：系统评价和荟萃分析。

Outcomes of surgical treatment for carcinoid heart disease: A systematic review and meta-analysis.

机构信息

Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA.

出版信息

Surgery. 2021 Aug;170(2):390-396. doi: 10.1016/j.surg.2021.02.054. Epub 2021 Mar 31.

DOI:10.1016/j.surg.2021.02.054

PMID:33812754

Abstract

BACKGROUND

Carcinoid heart disease (CaHD) develops from vasoactive substances released by neuroendocrine tumors, which can cause significant patient morbidity and mortality without surgical intervention. We performed a systematic review and meta-analysis to elucidate granular perioperative details and long-term outcomes in these patients.

METHODS

Electronic search of Ovid, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to examine surgical treatment of carcinoid disease. Nine articles comprising 416 patients were selected. Study-level data were extracted and pooled for meta-analysis.

RESULTS

Mean patient age was 63 years (95% confidence interval, 57-70) with 53% (95% confidence interval, 46-61) of patients being male. In addition, 75% (95% confidence interval, 54-96) of neuroendocrine tumors originated from the small bowel or colon and 98% (95% confidence interval, 93-100) had liver metastases. Right heart failure was present in 48% (95% confidence interval, 14-81). Moderate or severe regurgitation was present in 97% (95% confidence interval, 95-99) of tricuspid and 72% (95% confidence interval, 58-83) of pulmonary valves. In addition, 99% (95% confidence interval, 98-100) of tricuspid and 59% (95% confidence interval, 38-79) of pulmonary valves were replaced. Bioprosthetic valves were used in 80% (95% confidence interval, 68-93) of tricuspid positions. Mean hospital duration of stay was 16 days (95% confidence interval, 7-25). Thirty-day mortality was 9% (95% confidence interval, 6-12). Mean follow-up was 25 months (95% confidence interval, 11-39). Median survival was 3 years (95% confidence interval, 2.5-3.5).

CONCLUSION

For patients >18 years of age, surgical treatment of carcinoid heart disease can be performed with a reasonable safety profile. However, overall survival appears to have ongoing effects of the primary disease.

摘要

背景

类癌心脏疾病（CaHD）由神经内分泌肿瘤释放的血管活性物质引起，如果不进行手术干预，会导致患者出现严重的发病率和死亡率。我们进行了一项系统评价和荟萃分析，以阐明这些患者的围手术期细节和长期预后。

方法

通过 Ovid、Scopus、护理与联合健康文献累积索引和 Cochrane 对照试验登记处进行电子检索，以检查类癌疾病的手术治疗。选择了 9 篇文章，共 416 名患者。提取研究水平的数据并进行荟萃分析。

结果

患者的平均年龄为 63 岁（95%置信区间，57-70），其中 53%（95%置信区间，46-61）为男性。此外，75%（95%置信区间，54-96）的神经内分泌肿瘤起源于小肠或结肠，98%（95%置信区间，93-100）有肝转移。48%（95%置信区间，14-81）存在右心衰竭。97%（95%置信区间，95-99）的三尖瓣和 72%（95%置信区间，58-83）的肺动脉瓣存在中度或重度反流。此外，99%（95%置信区间，98-100）的三尖瓣和 59%（95%置信区间，38-79）的肺动脉瓣被替换。生物瓣在 80%（95%置信区间，68-93）的三尖瓣位置使用。平均住院时间为 16 天（95%置信区间，7-25）。30 天死亡率为 9%（95%置信区间，6-12）。平均随访时间为 25 个月（95%置信区间，11-39）。中位生存时间为 3 年（95%置信区间，2.5-3.5）。