开放手术与腔内修复治疗破裂腹主动脉瘤临床效果的Meta分析  

Meta-analysis of the clinical effect of open surgery repair and endovascular aortic repair in the treatment of ruptured abdominal aortic aneurysms

作　　者：张克 丁杰玲 续慧民 杨涛 郝斌 张文沛 孙磊 Zhang Ke;Ding Jielin;Xu Huimin;Yang Tao;Hao Bin;Zhang Wenpei;Sun Lei(Department of Vascular Surgery,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Third Hospital of Shanxi Medical University,Taiyuan 030032,China;Department of Urology,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Third Hospital of Shanxi Medical University,Taiyuan 030032,China)

机构地区：[1]山西白求恩医院,山西医学科学院同济山西医院,山西医科大学第三医院血管外科,太原030032 [2]山西白求恩医院山西医学科学院同济,山西医院山西医科大学第三医院泌尿外科,太原030032

出　　处：《中国血管外科杂志（电子版）》2022年第3期222-228,共7页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的比较开放手术(open surgical repair,OSR)与主动脉腔内修复术(endovascular aortic repair,EVAR)治疗破裂腹主动脉瘤的临床效果。方法系统性检索中国期刊全文数据库、中国生物医学数据库、维普、万方数据、中国知网、PubMed、MEDLINE、EMBASE、Cochrane Library等数据库2011年9月至2021年9月发表的相关文献。使用RevMan 5.3软件对患者采用OSR与EVAR的早期结局、中远期结局和并发症等情况进行Meta分析。结果共纳入25篇文献14700例患者,其中7357例患者行EVAR,7343例患者行OSR。Meta分析结果显示,EVAR组患者术后30 d死亡率(OR=0.55,95%CI=0.49~0.60,P<0.001)和并发症发生率(OR=0.42,95%CI=0.32~0.56,P<0.001)比OSR组低,但术后1年(OR=1.32,95%CI=1.20~1.44,P<0.001)和术后3年(OR=1.15,95%CI=1.04~1.28,P=0.006)的生存率亦比OSR组低;两组患者二次手术干预率(OR=1.55,95%CI=0.59~4.07,P=0.370)和术后5年生存率(OR=1.04,95%CI=0.92~1.19,P=0.510)差异无统计学意义。结论EVAR治疗破裂腹主动脉瘤的短期疗效较好,死亡率低,术后并发症相对较少,但长期效果还需要进一步观察。Objective To compare the clinical effect of open surgical repair(OSR)and endovascular aortic repair(EVAR)in the treatment of ruptured abdominal aortic aneurysms.Methods We systematically searched relevant literature published from September 2011 to September 2021 at Chinese Journal Full-text Database,China Biomedical Database,VIP Database,Wanfang Database,CNKI,PubMed Database,MEDLINE,EMBASE and Cochrane Library,and used RevMan 5.3 software to conduct a Meta-analysis on the early outcomes,mid-and long-term outcomes and complications of OSR and EVAR.Results A total of 25 literatures involving 14700 patients were included,with 7357 patients underwent EVAR and 7343 patients underwent OSR.Meta-analysis results showed that the 30-day mortality(OR=0.55,95%CI=0.49-0.60,P<0.001)and complication rate(OR=0.42,95%CI=0.32-0.56,P<0.001)in the EVAR group were significantly lower than those of OSR group,and the 1-year survival rate(OR=1.32,95%CI=1.20-1.44,P<0.001)and the 3-year survival rate(OR=1.15,95%CI=1.04-1.28,P=0.006)were also significantly lower than those of OSR group.The differences of secondary surgical intervention rate(OR=1.55,95%CI=0.59-4.07,P=0.370)and 5-year survival rate(OR=1.04,95%CI=0.92-1.19,P=0.510)of the two groups were not statistically significant.Conclusion The short-term effect of EVAR in the treatment of ruptured abdominal aortic aneurysm is satisfactory,with low mortality and relatively postoperative complications,but the longterm effect needs further observation.

关 键 词：开放手术 腔内修复术 腹主动脉瘤 破裂 META分析 

分 类 号：R654.3[医药卫生—外科学]