腔内修复术与开腹手术治疗腹主动脉瘤围手术期疗效的Meta分析  

Endovascular versus open repair for abdominal aortic aneurysms: a Meta-analysis of perioperative efficacy

作　　者：张建勇[1] 孟德凯[1,2] 时然然[2,3] 陈辉[1] 刘玉[4] 

机构地区：[1]新疆医科大学第四附属医院普外二科,新疆乌鲁木齐830000 [2]新疆医科大学研究生学院,新疆乌鲁木齐830000 [3]新疆医科大学第二附属医院消化内科,新疆乌鲁木齐830000 [4]新疆医科大学第一附属医院循证医学教研室,新疆乌鲁木齐830000

出　　处：《中国普通外科杂志》2013年第12期1562-1567,共6页China Journal of General Surgery

摘　　要：目的:系统评价方法比较血管腔内修复术与开腹术手术治疗腹主动脉瘤(AAA)的围手术期疗效。方法:检索国内外文献数据库,收集血管腔内修复术与开腹术手术治疗AAA的随机对照试验,采用RevMan5.1软件进行Meta分析。结果:共纳入7个随机对照试验,8篇文献,共2 807例患者,其中行血管腔内修复术1 433例(腔内组),开腹手术1 374例(开腹组)。Meta分析结果显示,腔内组较开腹组手术时间减少(SMD=-0.87,95%CI=-1.43--0.31,P=0.002),术中输血量减少(SMD=-0.83,95%CI=-0.94--0.72,P<0.00001),ICU监护时间缩短(MD=-38.11,95%CI=-48.61--27.61,P<0.00001),术后住院时间缩短(MD=-5.11,95%CI=-6.26--3.95,P<0.00001),术后30 d病死例数降低(OR=0.30,95%CI=0.16-0.55,P=0.0001)。结论:腔内修复治疗AAA较开腹手术具有创伤小、失血少、术后恢复快的优点,围手术期具有较大优势,但长期预后有待研究。Objective： To compare the perioperative efficacy of endovascular and open repair for AAA by means of systematic review. Methods： The literature of randomized controlled trials （RCTs） comparing endovascular and open repairfor AAA was collected by searching the national and international databases. Meta-analysis was performed by using Revrnan 5.1 software. Results： Seven randomized controlled trials with 8 reports were included, which involved a total of 2 807 patients, of whom 1 433 cases underwent endovascular repair （endovascular group） and 1 374 cases underwent open surgery （open surgery group）. Results of Meta-analyses showed that in endovascular group compared with open surgery group, the operative time and volume of intraoperative blood transfusion was reduced （Sh＇ID=-0.87, 95% CI=-1.43--0.31, P=0.002; SMD=-0.83, 95% CI=-0.94--0.72, P〈0.00001）, the length of postoperative stay in ICU and hospital was shortened （MD=-38.11, 95% C1=-48.61--27.61, P〈0.00001; MD=-5.11, 95% CI=-6.26--3.95, P〈0.00001）, and number of 30-day postoperative death was decreased （OR=0.30, 95% CI=0.16-0.55, P=0.0001）. Conclusion. Endovascular repair has the perioperative advantages of minimal trauma, reduced blood loss and quick postoperative recovery versus open surgery but its long term results still need further observation.

关 键 词：主动脉瘤 腹 外科学 腔内修复术 META分析 

分 类 号：R654.3[医药卫生—外科学]