唐超 1 , 曾智 2 , 李靜 3 , 曹文齋 1 , 黃萍 1
  • 1.四川大學(xué)華西臨床醫(yī)學(xué)院（成都 610041）2.四川大學(xué)華西醫(yī)院心內(nèi)科（成都 610041）3.四川大學(xué)華西醫(yī)院循證醫(yī)學(xué)與臨床流行病學(xué)中心（成都 610041）;

目的 　評價Amplatzer封堵器介入治療和外科手術(shù)治療繼發(fā)孔型房間隔缺損的有效性和安全性。
方法 　計算機(jī)檢索MEDLINE（1966～2006.7）、EMbase（1966～2006.7）、Cochrane圖書館（2006年第2期）和中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（1979～2006.7），收集所有相關(guān)隨機(jī)和非隨機(jī)對照試驗(yàn)，質(zhì)量評價后用RevMan4.2版軟件進(jìn)行Meta分析。
結(jié)果 　未獲得隨機(jī)對照試驗(yàn)，納入16個非隨機(jī)對照試驗(yàn)，共2 043例。結(jié)果顯示: ① 住院期間病死率：14個試驗(yàn)的住院期間病死率都為0，只有2個試驗(yàn)報道外科手術(shù)治療組各有1例死亡；② 12個試驗(yàn)（n=1 722）的Meta分析結(jié)果顯示，Amplatzer封堵器組的治療成功率略低于外科手術(shù)組，其差異有統(tǒng)計學(xué)意義[RR=0.95，95%CI（0.92，0.98）]；③ 6個試驗(yàn)（n=1 106）的Meta分析結(jié)果顯示，Amplatzer封堵器組術(shù)后24 h封堵成功率也略低于外科手術(shù)組，其差異有統(tǒng)計學(xué)意義[RR=0.96，95%CI（0.92，1.00）] ；④ 16個試驗(yàn)（n=1 977）的Meta分析結(jié)果顯示，Amplatzer封堵器組術(shù)后并發(fā)癥發(fā)生率低于外科手術(shù)治療組[RR=0.27，95%CI（0.21，0.35）]；⑤ 14個試驗(yàn)（n=1 807）的Meta分析結(jié)果顯示，Amplatzer封堵器組術(shù)后輸血明顯少于外科手術(shù)組[RR=0.03，95%CI（0.02，0.06）]。
結(jié)論 　Amplatzer封堵器介入治療繼發(fā)孔型房間隔缺損的成功率略低于手術(shù)治療組，但術(shù)后并發(fā)癥和術(shù)后輸血少，在適應(yīng)癥范圍內(nèi)可代替外科手術(shù)。

引用本文： 唐超,曾智,李靜,曹文齋,黃萍. Amplatzer封堵器和外科手術(shù)治療繼發(fā)孔型房間隔缺損的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2007, 07(4): 267-275. doi: 復(fù)制

1. Li T, Wang ZJ, Pan TG, et al. Comparison of Amplatzer occluder versus surgical for atrial septal defects. Chinese Journal of Practical Pediatrics, 2002; 17(10): 616-617.
2. Ruan J, Cai SJ, Lin RZ, et al. Comparison between Amplatzer septal occluder and surgical closure of secundum atrial septal defect. Journal of Clinical and Experimental Medicine, 2006, 5(6): 686-687.
3. Yang R, Kong XQ, Sheng YH, et al. Comparison between amplatzer septal occluder and surgical closure of secundum atrial septal defect. China Journal of Modern Medicine, 2003, 13(24): 33-36.
4. Yang ZW, Dai RP, Zhang GJ, et al. Comparison of efficacy and cost between transcatheter and surgical closure of secundum atrial septal defect. Chinese Journal of Cardiology, 2004; 32(5): 390-393.
5. Zhao ZN, Wu RZ, Zhao QF, et al. Comparison of transcatheter and surgical closure of atrial septal defect. J Appl Clin Pediatr, 2006; 21(13): 865-866.
6. Feng BX, Huang XS, Zhang JF, et al. Comparison study between transcatheter closure and surgical repair in over 50-year old patients with secundum atrial septal defect. Chin J Thorac Cardivasc Surg, 2004, 20(3): 139-141.
7. Guan SF, Pan X, Cui KJ, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect over 50 years of age. Chin J Intervernt Cardiol, 2005, 13(6): 357-360.
8. Carlgren LE. The incidence of congenital heart disease in children born in Gothenburg 1941-1950. Br Heart J, 1959, 21: 40-50.
9. Kirklin JW, Barratt-Boyes BG. Cardiac Surgery. 2nd ed. New York: Churchill Livingstone, 1993: 609-644.
10. King TD, Mills NL. Secundum atrial septal defects: non-operative closure during cardiac catheterization. JAMA, 1976, 235: 2506-2509.
11. Fischer G, Stieh J, Uebing A, et al. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart, 2003, 89(2): 199-204.
12. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):iii-x, 1-173.
13. Berger F, Vogel M, Alexi-Meskishvili V, et al. Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg, 1999, 118(4): 674-678; discussion 678-680.
14. Bialkowski J, Karwot B, Szkutnik M, et al. Closure of atrial septal defects in children: surgery versus Amplatzer device implantation. Tex Heart Inst J, 2004, 31(3): 220-223.
15. Cowley CG, Lloyd TR, Bove EL, et al. Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder. Am J Cardiol, 2001, 88(5): 589-591.
16. Du ZD, Hijazi ZM, Kleinman CS, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol, 2002, 39(11): 1836-1844.
17. Durongpisitkul K, Soongswang J, Laohaprasitiporn D, et al. Comparison of atrial septal defect closure using amplatzer septal occluder with surgery. Pediatr Cardiol, 2002, 23(1): 36-40.
18. Hughes ML, Maskell G, Goh TH, et al. Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart, 2002, 88(1): 67-70.
19. Kim JJ, Hijazi ZM. Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects. Med Sci Monit, 2002, 8(12): CR787-791.
20. Thomson JD, Aburawi EH, Watterson KG, et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart, 2002, 87(5): 466-469.
21. Vida VL, Barnoya J, O’Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol, 2006, 47(2): 326-331.
22. 李濤, 王作軍, 潘同國, 等. Amplatzer封堵器與心臟直視手術(shù)治療房間隔缺損的比較. 中國實(shí)用兒科雜志 2002; 17(10): 616-617.
23. 阮兢, 蔡仕俊, 林茹珠, 等. Amplatzer堵閉器與外科手術(shù)治療繼發(fā)孔型房間隔缺損的比較. 臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志, 2006; 5(6): 686-687.
24. 楊榮, 孔祥清, 盛燕輝, 等. 繼發(fā)孔房間隔缺損的Amplatzer 封閉器介入外科手術(shù)治療的對比研究. 中國現(xiàn)代醫(yī)學(xué)雜志 2003; 13(24): 33-36.
25. 楊振文, 戴汝平, 張戈軍, 等. 繼發(fā)孔型房間隔缺損介入治療和外科手術(shù)的對比分析. 中華心血管雜志, 2001, 32(5): 390-393.
26. 趙子牛，吳蓉洲，趙琦峰, 等. 房間隔缺損介入與外科手術(shù)治療療效對比. 實(shí)用兒科臨床雜志, 2006, 21(13): 865-866.
27. .馮碧霞, 黃新勝, 張鏡芳, 等. 50歲以上房間隔缺損介入與外科治療的對比研究. 中華胸心血管外科雜志, 2004, 20(3): 139-141.
28. 關(guān)韶峰，潘新，崔克儉, 等. 50歲以上繼發(fā)孔型房間隔缺損患者介入治療和外科手術(shù)的對比分析. 中國介入心臟病學(xué)雜志, 2005, 13(6): 357-360.
29. Rao PS. Transcatheter closure of atrial septal defect: are we there yet? J Am Coll Cardiol, 1998, 31(5): 1117-1119.
30. Hijazi Z, Wang Z, Cao Q, et al. Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv, 2001, 52(2): 194-199.
31. Ewert P, Berger F, Daehnert I, et al. Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method. Circulation, 2000, 101(8): 847-849.
  1. 1. Li T, Wang ZJ, Pan TG, et al. Comparison of Amplatzer occluder versus surgical for atrial septal defects. Chinese Journal of Practical Pediatrics, 2002; 17(10): 616-617.
  2. 2. Ruan J, Cai SJ, Lin RZ, et al. Comparison between Amplatzer septal occluder and surgical closure of secundum atrial septal defect. Journal of Clinical and Experimental Medicine, 2006, 5(6): 686-687.
  3. 3. Yang R, Kong XQ, Sheng YH, et al. Comparison between amplatzer septal occluder and surgical closure of secundum atrial septal defect. China Journal of Modern Medicine, 2003, 13(24): 33-36.
  4. 4. Yang ZW, Dai RP, Zhang GJ, et al. Comparison of efficacy and cost between transcatheter and surgical closure of secundum atrial septal defect. Chinese Journal of Cardiology, 2004; 32(5): 390-393.
  5. 5. Zhao ZN, Wu RZ, Zhao QF, et al. Comparison of transcatheter and surgical closure of atrial septal defect. J Appl Clin Pediatr, 2006; 21(13): 865-866.
  6. 6. Feng BX, Huang XS, Zhang JF, et al. Comparison study between transcatheter closure and surgical repair in over 50-year old patients with secundum atrial septal defect. Chin J Thorac Cardivasc Surg, 2004, 20(3): 139-141.
  7. 7. Guan SF, Pan X, Cui KJ, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect over 50 years of age. Chin J Intervernt Cardiol, 2005, 13(6): 357-360.
  8. 8. Carlgren LE. The incidence of congenital heart disease in children born in Gothenburg 1941-1950. Br Heart J, 1959, 21: 40-50.
  9. 9. Kirklin JW, Barratt-Boyes BG. Cardiac Surgery. 2nd ed. New York: Churchill Livingstone, 1993: 609-644.
  10. 10. King TD, Mills NL. Secundum atrial septal defects: non-operative closure during cardiac catheterization. JAMA, 1976, 235: 2506-2509.
  11. 11. Fischer G, Stieh J, Uebing A, et al. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart, 2003, 89(2): 199-204.
  12. 12. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27):iii-x, 1-173.
  13. 13. Berger F, Vogel M, Alexi-Meskishvili V, et al. Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg, 1999, 118(4): 674-678; discussion 678-680.
  14. 14. Bialkowski J, Karwot B, Szkutnik M, et al. Closure of atrial septal defects in children: surgery versus Amplatzer device implantation. Tex Heart Inst J, 2004, 31(3): 220-223.
  15. 15. Cowley CG, Lloyd TR, Bove EL, et al. Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder. Am J Cardiol, 2001, 88(5): 589-591.
  16. 16. Du ZD, Hijazi ZM, Kleinman CS, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol, 2002, 39(11): 1836-1844.
  17. 17. Durongpisitkul K, Soongswang J, Laohaprasitiporn D, et al. Comparison of atrial septal defect closure using amplatzer septal occluder with surgery. Pediatr Cardiol, 2002, 23(1): 36-40.
  18. 18. Hughes ML, Maskell G, Goh TH, et al. Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart, 2002, 88(1): 67-70.
  19. 19. Kim JJ, Hijazi ZM. Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects. Med Sci Monit, 2002, 8(12): CR787-791.
  20. 20. Thomson JD, Aburawi EH, Watterson KG, et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart, 2002, 87(5): 466-469.
  21. 21. Vida VL, Barnoya J, O’Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol, 2006, 47(2): 326-331.
  22. 22. 李濤, 王作軍, 潘同國, 等. Amplatzer封堵器與心臟直視手術(shù)治療房間隔缺損的比較. 中國實(shí)用兒科雜志 2002; 17(10): 616-617.
  23. 23. 阮兢, 蔡仕俊, 林茹珠, 等. Amplatzer堵閉器與外科手術(shù)治療繼發(fā)孔型房間隔缺損的比較. 臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志, 2006; 5(6): 686-687.
  24. 24. 楊榮, 孔祥清, 盛燕輝, 等. 繼發(fā)孔房間隔缺損的Amplatzer 封閉器介入外科手術(shù)治療的對比研究. 中國現(xiàn)代醫(yī)學(xué)雜志 2003; 13(24): 33-36.
  25. 25. 楊振文, 戴汝平, 張戈軍, 等. 繼發(fā)孔型房間隔缺損介入治療和外科手術(shù)的對比分析. 中華心血管雜志, 2001, 32(5): 390-393.
  26. 26. 趙子牛，吳蓉洲，趙琦峰, 等. 房間隔缺損介入與外科手術(shù)治療療效對比. 實(shí)用兒科臨床雜志, 2006, 21(13): 865-866.
  27. 27. .馮碧霞, 黃新勝, 張鏡芳, 等. 50歲以上房間隔缺損介入與外科治療的對比研究. 中華胸心血管外科雜志, 2004, 20(3): 139-141.
  28. 28. 關(guān)韶峰，潘新，崔克儉, 等. 50歲以上繼發(fā)孔型房間隔缺損患者介入治療和外科手術(shù)的對比分析. 中國介入心臟病學(xué)雜志, 2005, 13(6): 357-360.
  29. 29. Rao PS. Transcatheter closure of atrial septal defect: are we there yet? J Am Coll Cardiol, 1998, 31(5): 1117-1119.
  30. 30. Hijazi Z, Wang Z, Cao Q, et al. Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv, 2001, 52(2): 194-199.
  31. 31. Ewert P, Berger F, Daehnert I, et al. Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method. Circulation, 2000, 101(8): 847-849.