外科手术和介入技术治疗主动脉缩窄的meta分析  

Surgery versus endovascular management in coarctation of the aorta:a meta-analysis

作　　者：蒙延海[1] 田川[1] 裴华伟[1] 王春茂[1] 熊文龙[1] 刘文芝[1] 常谦[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管外科心血管疾病国家重点实验室,100037

出　　处：《心血管外科杂志（电子版）》2013年第2期25-30,共8页Journal of Cardiovascular Surgery(Electronic Edition)

基　　金：国家自然科学基金(81070252);中央级公益性科研院所科研基金(2012-F14)

摘　　要：目的：评价外科手术和介入技术（球囊或支架）治疗主动脉缩窄（ CoA）的疗效。方法计算机检索PubMed，Embase，Cochrane图书馆，中国期刊全文数据库（CNKI）及维普数据库（VIP）里的外科手术和介入技术治疗主动脉缩窄的临床对照研究。文献检索时间从建库至2013年3月。根据The Newcastle-Ot-tawa Scale（ NOS）量表评价纳入文献的质量并提取资料。对符合质量标准的对照研究采用Rev Man 5.2进行异质性检验及meta分析。结果检出相关文献816篇，根据纳入标准最终入选10篇文献；共入选病例785例。与外科组相比，介入组在术后随访期再狭窄（ OR：0.21；95％CI：0.11～0.38）、主动脉瘤形成（ OR：0.52；95％CI：0.29～0.93）及再干预（ OR：0.56；95％CI：0.35～0.89）的发生率上明显增加，差异具有统计学意义（分别P＜0.01，P＝0.03，P＝0.02）；介入组患者的住院时间明显缩短（ SMD：3.64；95％CI：2.49～4.80），差异具有统计学意义（ P＜0.01）；外科组与介入组在术后早期并发症的发生率上无明显差异，但倾向于外科组早期并发症多（ OR：2.03；95％CI：0.74～5.51；P＝0.17）。结论外科手术仍然是治疗CoA的主要方式，远期并发症和再干预率低于介入治疗；支架技术治疗成人CoA早中期效果显著，远期效果有待于进一步的随访。Objective To conduct a meta-analysis of the effectiveness and safety of endovascular management compared with open surgery in patients with coarctation of the aorta ( CoA ) .Methods PubMed , Embase , the Cochrane Controlled Trials Register databases , CNKI and VIP databases were searched , and study eligibility and conducted data abstraction were determined independently and in duplicate .The studies that the observational or randomized control trials comparing endovascular treatment with open surgery in CoA were included .Literature searches from database establishment to March 2013 .The heterogeneity and data were analyzed by the software of Rev Man 5.2 .Results Of 816 studies identified ,10 studies met eligibility criteria ,and included a total of 785 patients.The incidence of recoarctation(OR:0.21;95%CI:0.11-0.38),aortic aneurysm(OR:0.52;95% CI:0.29-0.93 ) and reintervention ( OR:0.56;95% CI:0.35-0.89 ) during follow-up were significantly increased respectively ( P<0.01 ,P=0.03 ,P=0.02 ,respectively ) in endovascular treatment group than in surgery group.Converse results were shown in median hospitalization time (SMD:3.64;95% CI:2.49-4.80,P<0.01). There was no significant difference in early complications ( OR:2.03;95% CI:0.74-5.51;P =0.17 ) between&nbsp;surgery group and endovascular group .Conclusions Surgery has proven to be and remains an effective treatment for the management of CoA ,the risk for recoarctation and aneurysm formation seems to be lower than endovascular treatment.There are excellent short-term and intermediate-term results in stent management of CoA in adult patients,still,long-term follow-up data are necessary .

关 键 词：主动脉缩窄 外科手术 放射学 介入性 支架 

分 类 号：R654.2[医药卫生—外科学]