外科与介入手术治疗冠状动脉心肌桥临床疗效和预后的系统评价

卢晓峰; 张朋宾; 李娜娜; 李勇男; 陶震泽; 高秉仁; 柳德斌

doi:10.16016/j.1000-5404.201908138

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外科与介入手术治疗冠状动脉心肌桥临床疗效和预后的系统评价

临床医学 | 更新时间：2026-01-09

- 外科与介入手术治疗冠状动脉心肌桥临床疗效和预后的系统评价
- Efficacy and outcomes of surgical versus interventional treatment of coronary myocardial bridge: a systematic review
- 第三军医大学学报 2020年42卷第2期页码：2020-214
- 作者机构：
  
  730030 甘肃兰州，兰州大学第二医院心脏外科1科
- 作者简介：
  
  [柳德斌，E-mail:ery_liudb@lzu.edu.cn LIU Debin, E-mail:ery_liudb@lzu.edu.cn
- 基金信息：
  
  兰州市人才创新创业项目(2017-RC-63);兰州大学第二医院“萃英科技创新”计划项目(CY2017-BJ01)
- DOI：10.16016/j.1000-5404.201908138
  中图分类号： R181.23;R541.1;R654.2
- 收稿：2019-08-19，
  
  修回：2019-10-15，
  
  纸质出版：2020-01-30
- 稿件说明：
移动端阅览
卢晓峰, 张朋宾, 李娜娜, 等. 外科与介入手术治疗冠状动脉心肌桥临床疗效和预后的系统评价[J]. 第三军医大学学报, 2020,42(2):2020-214.

Xiaofeng LU, Pengbin ZHANG, Nana LI, et al. Efficacy and outcomes of surgical versus interventional treatment of coronary myocardial bridge: a systematic review[J]. Journal of Third Military Medical University, 2020, 42(2): 2020-214.
卢晓峰, 张朋宾, 李娜娜, 等. 外科与介入手术治疗冠状动脉心肌桥临床疗效和预后的系统评价[J]. 第三军医大学学报, 2020,42(2):2020-214. DOI： 10.16016/j.1000-5404.201908138.

Xiaofeng LU, Pengbin ZHANG, Nana LI, et al. Efficacy and outcomes of surgical versus interventional treatment of coronary myocardial bridge: a systematic review[J]. Journal of Third Military Medical University, 2020, 42(2): 2020-214. DOI： 10.16016/j.1000-5404.201908138.

摘要

目的

通过系统评价的方法对比外科手术与介入手术治疗冠状动脉心肌桥的疗效及预后。

方法

通过关键词搜索在PubMed、EMbase、Cochrane Library、知网和万方数据库进行系统性检索，获取关于手术治疗冠状动脉心肌桥的研究文献。经研究者筛选文献、提取资料后，对纳入的研究进行系统评价与分析，并对样本量、手术方式、国家(亚洲和其他)、发表年份进行回归分析探索异质性来源。

结果

共获取3 584篇英文文献，1 678篇中文文献，去除重复后共计4 019篇文献。最终纳入33项研究，共计1 286例患者进行定性分析。其中26项研究共计572例患者纳入定量分析。单个率的合成分析显示:手术治疗冠状动脉心肌桥的总体症状

缓解率为88.00%(95%

:81.31%~93.56%)，总体术后血管再狭窄率为9.09%(95%

:4.30%~15.05%)

术中并发症及术后心血管事件率分别为0.59%(95%

:0.00%~1.83%)、0.46%(95%

:0.00%~1.63%)。回归分析显示术后症状缓解率、血管再狭窄率与不同手术方式具有相关性(

0.001)

而与样本量、发表年份、国家无关(

0.1)。亚组分析显示外科手术术后症状缓解率(95.45%

67.21%，

0.001)、血管再狭窄(3.89%

24.33%，

0.001)与术后心血管事件(0.01%

2.91%，

0.001)均优于介入手术，外科手术和介入手术在术中并发症发生率(1.65%

0.00%，

=0.1 405)无明显差异。

结论

当前证据表明外科手术相对于介入手术在治疗冠状动脉心肌桥具有较高的术后症状缓解率和较低的血管再狭窄率，不过仍需开展更高质量的大样本随机对照试验加以验证。

Abstract

Objective

To compare the efficacy and outcomes of surgical operations (myotomy and bypass surgery) and coronary stenting for treatment of coronary myocardial bridge.

Methods

We searched PubMed

Embase

Cochrane Library

China National Knowledge Infrastructure and Wanfang database for studies of treatment of coronary artery myocardial bridge with coronary stenting

myotomy or coronary artery bypass grafting. The data were extracted from the eligible studies

and regression analysis was performed to explore the sources of heterogeneity in the sample size

surgical methods

nations (Asian and others)

and year of publication.

Results

There were 3 584 English articles and 1 678 Chinese articles reviewed in this study

and finially 4 019 articles were recruited after removing duplicate ones. Thirty-three eligible studies involving a total of 1 286 patients were included in the qualitative analysis. A total of 572 patients from 26 studies were included in the quantitative analysis. Analyses of the single rates showed that the overall symptom remission rate of myocardial bridge was 88.00% (95%

: 81.3

1%-93.56%) following surgical interventions

which were associated with an overall postoperative coronary artery restenosis rate of 9.09% (95%

: 4.30%-15.05%) and overall rates of intraoperative complications and postoperative cardiovascular events of 0.59% (95%

: 0.00%-1.83%) and 0.46% (95%

: 0.00%-1.63%)

respectively. Regression analysis showed that postoperative symptom relief and coronary artery restenosis rates were significantly correlated with the surgical methods used (

0.001) but not with the sample size

year of publication

or nationalities of the patients (

0.1). Subgroup analysis showed that compared with interventional treatment

surgical treatments resulted in a significantly higher rate of postoperative symptom relief (95.45%

68.82%

0.001) and lower rates of coronary artery restenosis (3.89%

21.78%

0.001) and postoperative cardiovascular events (0.01%

2.91%

0.001). The incidence of intraoperative complications did not differ significantly between surgical and interventional treatments (1.65%

0.00%

=0.1405).

Conclusion

Surgical treatments result in a higher rate of postoperative symptom relief and a lower postoperative restenosis rate than interventional treatment

but high-quality randomized controlled trials with a large sample size are still needed to verify this conclusion.

关键词

Keywords

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