Oncol2012: 破裂型腹主动脉瘤开放手术与腔内修复术中远期疗效的比较：Meta分析

A Comparative Study on the Medium-long Term Results of Endovascular Repair and Open Surgical Repair in management of Ruptured Abdominal Aortic Aneurysms.

Purpose: To compare and summarize published results of ruptured abdominal aortic aneurysms undergoing endovascular repair with open surgical repair.Methods: A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods.Results: A search of the published literature showed that fourteen English language papers comprising totally 1,213 patients of ruptured abdominal aortic aneurysm (435 endovascular repair and 778 open surgical repair) would be suitable for use in this study. Furthermore, 13 Chinese studies are included, there are totally 267 patients of rAAA, among which there are 238 patients received operation. The endovascular method was associated with a more respiratory diseases before treatment (OR=1.81, P= .01), while there are more patients with hemodynamic instability before treatment in open surgical repair group (OR=1.53, P= .031). Mean blood transfusion was 1,328ml for endovascular repair and 2,809ml for open surgical repair (WMD-1500ml, P= .014). The endovascular method was associated with a shorter stay in intensive care (WMD-2.34days, P< .001) and a shorter total postoperative stay (WMD-6.27days, P< .001). The pooled postoperative complication rate of respiratory system and visceral ischemia was seldom occurred in EVAR group (OR=0.48, P< .001 and OR=0.28, P= .043 respectively). The pooled 30-day mortality was 25.7% for endovascular repair and 39.6% for open surgical repair, and the odds ratio was 0.53 (95 per cent CI: 0.41-0.70, P< .001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR=1.13, P= .381) and re-intervention rate (OR= 2.19, P= .243) following endovascular repair. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR=0.33, P= .039) at late follow-up period.Conclusion: On the basis of this systematic review ruptured abdominal aortic aneurysm endovascular repair results in less blood used for transfusion, shorter operation time, shorter intensive care unit and hospital stays and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.