临时血管分流术对伴有四肢血管损伤的保肢术后并发症的影响:Meta分析  

Meta-analysis of the effects of temporary intravascular shunt on postoperative complications after limb salvage of vascular injury in extremities

作　　者：肖栋超 竺枫[1] 李斯宏[1] 李俊杰[1] 陈益[1] 潘佳栋[1] 王欣[1] XIAO Dongchao;ZHU Feng;LI Sihong;LI Junjie;CHEN Yi;PAN Jiadong;WANG Xin(Department of Hand Surgery,Ningbo Sixth Hospital,Ningbo,Zhejiang Province 315040,China)

机构地区：[1]宁波市第六医院手外科,浙江宁波315040

出　　处：《中华显微外科杂志》2024年第2期195-200,共6页Chinese Journal of Microsurgery

基　　金：宁波市重大科技任务攻坚项目(2022Z146);宁波市医疗卫生高端团队重大攻坚项目(2022020506)。

摘　　要：目的探讨对伴有血管损伤的肢体行保肢术中使用临时血管分流术(TIVS)对术后并发症的影响,为临床上严重肢体创伤保肢决策提供参考。方法宁波市第六医院手外科在PubMed、Cochrane Library、Embase、知网、万方、维普数据库中检索2000年1月1日至2022年12月31日有关四肢血管损伤保肢中使用与不使用TIVS术后并发症比较的文献,按照纳入、排除标准筛选并提取文献,采用RevMan 5.4软件进行Meta分析。结果共纳入8项研究,包括1382个病例,其中328例使用了TIVS,1054例未使用TIVS。与不使用TIVS相比,使用TIVS后截肢率较低[OR=0.46,95%CI:(0.28,0.78),Z=2.91,P=0.004],肢体缺血时间较少[MD=-99.34,95%CI:(-123.65,-75.03),Z=8.01,P<0.01],血栓发生率较高[OR=1.97,95%CI:(1.14,3.42),Z=2.41,P=0.02],差异有统计学意义(P<0.05);筋膜切开率[OR=0.84,95%CI:(0.30,2.36),Z=0.32,P=0.75]与感染发生率[OR=0.88,95%CI:(0.35,2.19),Z=0.27,P=0.78]两组间比较差异无统计学意义(P>0.05)。结论在伴有血管损伤的肢体进行保肢手术中使用TIVS,可能会降低截肢率,缩短肢体缺血时间,但可能提高血栓发生率。Objective To explore the effects of temporary intravascular shunts(TIVS)on postoperative complications in limb salvage surgery with vascular injury,and to provide reference for clinical decision making.Methods The literature of postoperative complications of limb salvage with and without TIVS were searched by Department of Hand Surgery Ningbo Sixth Hospital on PubMed,Cochrane Library,Embase,CNKI,Wanfang Date and VIP databases from 1st January 2000 to 31st December 2022.References were screened and extracted according to inclusion and exclusion criteria,and Meta-analysis was performed using RevMan 5.4 software.Results Eight studies with 1382 cases were included,328 of which used TIVS and 1054 did not.Compared with non-TIVS group,the TIVS group was associated with a lower rate of amputation[OR=0.46,95%CI:(0.28,0.78),Z=2.91,P=0.004]and less limb ischemic time[MD=-99.34,95%CI:(-123.65,-75.03),Z=8.01,P<0.01],however the incidence of thrombosis was higher[OR=1.97,95%CI:(1.14,3.42),Z=2.41,P=0.02],the incidence difference of fasciotomy[OR=0.84,95%CI:(0.30,2.36),Z=0.32,P=0.75]and infection[OR=0.88,95%CI:(0.35,2.19),Z=0.27,P=0.78]were not statistically significant.Conclusion During the limb salvage surgery with vascular injury,the use of TIVS may reduce amputation rate and shoten the limb ischemia time,but it may increase the incidence of thrombosis.

关 键 词：临时血管分流 血管损伤 保肢术 血栓 荟萃分析 

分 类 号：R658[医药卫生—外科学]