高龄腹主动脉瘤患者治疗方式的选择及疗效比较  

A Meta analysis on endovascular vs open repair for abdominal aortic aneurysm in patients aged 80 and older

作　　者：韩彦槊[1] 张健[1] 姜晗[1] 沈世凯[1] 宋健博[1] 唐佃俊 辛世杰[1] 段志泉[1] 

机构地区：[1]中国医科大学附属第一医院普通外科教研室血管甲状腺外科,沈阳110001

出　　处：《中华普通外科杂志》2015年第12期987-991,共5页Chinese Journal of General Surgery

摘　　要：目的系统评价80岁以上高龄腹主动脉瘤患者的传统手术及腔内治疗的疗效。方法计算机检索1991年1月至2014年7月MEDLINE、Ovid、CBM和CNKI数据库。根据纳入和排除标准由两名研究者按Coehrane系统评价方法，独立选择文献、提取资料、评价各研究的方法学质量以及提取有效数据，采用STATA12．0软件进行Meta分析。结果共纳入8篇相关文献：共统计13490例高龄腹主动脉瘤（abdominalaoaicaneurysm，AAA）患者，其中腔内修复技术（endovascularrepair，EVAR）组6763例，人工血管移植术（opensu蛹calrepair，OSR）组6727例。术后早期EVAR组的心脏并发症发生率明显低于OSR组，差异有统计学意义（OR=0．092，P=0．008）；肺部并发症低于OSR组（OR=0．059，P=0．011）；术后肾脏并发症低于OSR组，差异有统计学意义（OR=0．097，P=0．007）；但脑血管并发症，2组之间差异无统计学意义（OR=0．156，P=0．172）。30d死亡率EVAR亦明显低于OSR（OR=0．240，95％CI：0．197—0．293，P〈0．001）。4篇文献中远期死亡率显示：平均3年的随访期内EVAR组和OSR组的高龄患者死亡率差异无统计学意义（OR=1．14．P=0．208）。亚组分析：对纳入例数〉100例的4项大型临床试验结果进行荟萃分析，EVAR组30d死亡率低于OSR组。结论由于EVAR的早期死亡率低且早期并发症少，80岁以上的高龄腹主动脉瘤可从中获益并应首选：EVAR和OSR的中远期生存率相当。Objective To investigate the therapeutic effect between endovascular repair （EVAR） and open surgical repair （OSR） of AAA in patients aged ≥80 years. Methods We searched MEDLINE （ 1991.1 -2014. 7）, Ovid （ 1991.1 -2014. 7）, CBM （ 1998. 1 -2014. 7） and CNKI （ 1998.1 -2014. 7） database. Meta-analyses was performed through software STATA 12. 0. Results Eight observational studies reporting on 13 490 octogenarian AAAs were included in this analysis. 6 763 AAA patients underwent EVAR and 6 727 AAAs underwent OSR. Although EVAR did not reduce cerebrovascular complication （OR =0. 156, P = O. 172）, EVAR was associated with a significantly lower risk of postoperative cardiac complications （ OR = 0. 092, P = 0. 008 ）, pulmonary complications （ OR = 0. 059, P = 0. 011 ） and renal complications （ OR = 0. 097, P = 0. 007 ） . Pooled analysis showed lower 30-day mortality after EVAR compared with OSR （ OR = 0. 240, 95% CI： O. 197 - 0. 293, P 〈 0. 001 ）. As for medium-long term results, four studies found similar overall survival at 3 years after EVAR and open repair （ OR = 1.14, P = 0. 208 ）. Sensitivity analysis including four studies （recruiting AAAs more than 100 cases in each study） found similar 30-day mortality. Conclusions EVAR in aged 80 and older AAAs is associated with significantly lower 30-day mortality and morbidity than OSR.

关 键 词：主动脉瘤 腹 META分析 老年人 80以上 死亡率 

分 类 号：R656[医药卫生—外科学]