二尖瓣瓣膜病行右前外侧小切口与胸骨正中切口手术研究的meta分析

研究目的：二尖瓣瓣膜病越来越趋向于应用右前外侧小切口（ALMT）替代胸骨正中切口（MS）进行手术，因为其史美观、微创。本文主要是比较分析ALMT组与MS组的手术参数及术后结果。研究方法：从1996年1月至2013年1月期间发表的英文论文中，选出1篇随机对照研究及4篇病例对照研究进行分析。重要结论：目前的临床数据显示，相比较于传统的胸骨正中切口二尖瓣手术，右前外侧小切口手术是一种安全、有效的方法，具有较好的近期和远期疗效。

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease： a meta-analysis

Objective： Mitral valve disease tends to be treated with anterolateral minithoracotomy （ALMT） rather than median stemotomy （MS）, as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods： One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results： ALMT showed a significantly longer cardiopulmonary bypass time （P=0.001） and aortic cross-clamp time （P=0.05） compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay （P〈0.00001）. According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS （P=0.05）; however, the incidence of peri-operative mortality （P=0.62）, re-operation for bleeding （P=0.37）, neurologic events （P=0.77）, myocardial infarction （P=0.84）, gastrointestinal complications （P=0.89）, and renal insufficiency （P=0.67） were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions： Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.