摘要
目的系统评价血管腔内修复术（ vascular edovascular repair, EVAR）治疗腹主动脉瘤破裂（ ruptured abdominal aortic aneurysms, RAAA）的有效性与安全性。方法计算机检索PubMed、MEDLINE、EMBASE、CochraneLibrary、中国生物医学文献数据库、中文科技期刊全文数据库及中国期刊全文数据库等数据库，并辅以手工检索近年发表的中文期刊。对纳入文献采用RevMan5．0．18软件进行Meta分析。结果纳入9篇文献。1篇随机对照试验（RCT），8篇队列研究共2402例患者，Meta分析结果显示：与开放手术比较，血管腔内修复术可明显降低术后30d死亡率[OR=0．47，95％C／（0．39，0．57），P〈0．01]和并发症发生率OR=0．47，95％CI（0．39，0．57），P〈0．01。血管腔内修复术与开放手术相比，在术后早期再手术率[OR=0．86，95％CI（o．55，1．33），P=0．5]及中期死亡率[OR=1．24，95％CI（0．46，3．37），P〈0．67]方面差异无统计学意义（P〉0．05）。结论对于合适的腹主动脉瘤破裂的患者，腔内治疗是可行的，并且逐渐显现出相对传统开腹手术更大的优势，短期疗效较好，术后并发症相对较少。
Objective To evaluate the efficacy and safety of endovascular aneurysm repair （EVAR） for ruptured abdominal aortic aneurysm （RAAA）. Methods Two reviewers searched PubMed, MEDLINE, EMBASE, Cochrane Library, Chinese Biomedical Literature Database （CBM）, Chinese Scientific Journal Full-text Database （CSJD）, and Chinese Journal Full-text Database（ CJFD）, added with handsearching and other retrievals. The Cochrane Collaboration＇s RevMan 5. 0. 18 was used for meta- analyses. Results Pooled data in 9 observational studies describing 2402 people. Meta-analyses showed that EVAR was superior to open repair （OR） as measured by the 30-day all cause mortality [ OR = 0. 47, 95% CI （0. 39,0.57）, P 〈0. 01 ] and the primary postoperative complications [ OR =0. 59, 95% CI（0. 43, 0. 81 ） ,P = 0. 001 ]. Endovascular repair compared with open surgery, in the early postoperative reoperation rate [ OR = 0. 86,95 % CI（ 0. 55,1.33 ）, P = 0. 5 ] and the mid-term all-cause mortality [ OR = 1.24,95 % CI （0. 46,3.37 ）, P = 0. 67 ] was not different statistically. Conclusions Short-term decrease of mortality after endovascular repair for ruptured aneurysms appears promising in selected patients, but the overall benefit is still not clear. Further research is needed to define the indications for REVAR in patients presenting with RAAA.
出处
《中华普通外科杂志》
CSCD
北大核心
2011年第11期910-913,共4页
Chinese Journal of General Surgery
关键词
动脉瘤
破裂
主动脉瘤
腹
META分析
腔内治疗
系统评价
Aneurysm,ruptured
Aortic aneurysm, abdominal
Meta-analysis
Endovascular repair
Systematic review
作者简介
通信作者：李晓勇，E—mail：kuerlelxy@126．com
