覆膜支架介入治疗逆撕型Stanford A型主动脉夹层及壁间血肿的系统评价与Meta分析  

Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma: A systematic review and meta-analysis

作　　者：朱翰朝 侯鹏 陈正希 夏麟 张溧昀 俞世强 刘金成 段维勋 ZHU Hanzhao;HOU Peng;CHEN Zhengxi;XIA Lin;ZHANG Liyun;YU Shiqiang;LIU Jincheng;DUAN Weixun(Department of Cardiovascular Surgery,The First Affiliated Hospital of Air Force Military Medical University,Xi’an,710032,P.R.China)

机构地区：[1]空军军医大学第一附属医院心血管外科,西安710032

出　　处：《中国胸心血管外科临床杂志》2020年第9期1037-1044,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2016YFC1301900);国家自然科学基金(81870218;81570230);陕西省重点研发计划重点项目-社会发展领域(2017ZDXM-SF-051)。

摘　　要：目的通过单臂Meta分析评价覆膜支架介入治疗逆撕型Stanford A型主动脉夹层及壁间血肿的预后情况。方法计算机检索PubMed、EMbase、The Cochrane Library、万方、维普、中国知网和中国生物医学文献数据库中有关覆膜支架介入治疗逆撕型Stanford A型主动脉夹层和壁间血肿的相关文献,检索时限从建库至2020年1月。由研究员逐步筛选文献,并对纳入文献进行质量评价,收集整理数据,采用R3.6.3软件进行单臂Meta分析。结果共纳入英文文献12篇,中文文献5篇。纳入文献均为病例系列研究,文献整体质量经纽卡斯尔-渥太华量表(NOS)评价后较一般。通过对260例患者的临床预后分析,发现覆膜支架介入治疗术后30 d死亡率6%[95%CI(0.04,0.11),P=0.97]、术后晚期死亡率8%[95%CI(0.05,0.14),P=0.78]、术后内漏发生率21%[95%CI(0.16,0.29),P=0.06]、脑卒中发生率5%[95%CI(0.03,0.09),P=0.99]、新发夹层发生率7%[95%CI(0.04,0.11),P=0.96]、夹层进展发生率10%[95%CI(0.07,0.16),P=0.24]、壁间血肿吸收率84%[95%CI(0.37,1.00),P<0.01]。结论覆膜支架介入治疗逆撕型Stanford A型主动脉夹层及壁间血肿对于部分患者可以获得较好的早期治疗效果,并且可以作为此类高龄、高危、无法耐受外科手术患者安全有效的治疗方法,内漏、脑卒中及逆撕形成新发夹层是该技术早期主要严重并发症。Objective To evaluate the prognosis of interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma by single-arm meta-analysis.Methods Related studies on treating retrograde Stanford type A aortic dissection and intramural hematoma with covered stent graft were retrieved from the databases by computer,including PubMed,EMbase,The Cochrane Library,Wanfang Data,VIP,CNKI and CBM,from inception to January 2020.Literatures were screened by researchers step by step according to the predefined inclusion and exclusion criteria.Quality of the enrolled literatures was evaluated,and data were extracted from the included studies.Afterwards,single-arm meta-analysis was carried out by the R3.6.3 software.Results A total of 12 English and 5 Chinese studies were included,which were all case series,and the quality of all literatures was moderate evaluated by Newcastle-Ottawa Scale(NOS).After analyzing the clinical prognosis of 260 patients,the 30-day mortality was 6%(95%CI 0.04 to 0.11,P=0.97),the late mortality was 8%(95%CI 0.05 to 0.14,P=0.78),the incidence of endoleak was 21%(95%CI 0.16 to 0.29,P=0.06),the incidence of stroke was 5%(95%CI 0.03 to 0.09,P=0.99),the incidence of new aortic dissection was 7%(95%CI 0.04 to 0.11,P=0.96),the incidence of dissection progression was 10%(95%CI 0.07 to0.16,P=0.24),and the absorption rate of intramural hematoma was 84%(95%CI 0.37 to 1.00,P<0.01).Conclusion Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma can obtain good early treatment results for some patients,and can be used as a safe and effective treatment for aged patient with high risk who cannot tolerate surgery.Endoleak,stroke and new aortic dissection are the early serious complications of this method.

关 键 词：逆撕型 Stanford A型 主动脉夹层 覆膜支架介入治疗 系统评价/META分析 

分 类 号：R543.1[医药卫生—心血管疾病]