腔内修复术与开腹手术治疗腹主动脉瘤围手术期疗效的Meta分析

目的：系统评价方法比较血管腔内修复术与开腹术手术治疗腹主动脉瘤（AAA）的围手术期疗效。方法：检索国内外文献数据库，收集血管腔内修复术与开腹术手术治疗AAA的随机对照试验，采用RevMan5.1软件进行Meta分析。结果：共纳入7个随机对照试验，8篇文献，共2 807例患者，其中行血管腔内修复术1?433例（腔内组），开腹手术1 374例（开腹组）。Meta分析结果显示，腔内组较开腹组手术时间减少（SMD=-0.87，95% CI=-1.43--0.31，P=0.002），术中输血量减少（SMD=-0.83，95% CI=-0.94--0.72，P<0.00001），ICU监护时间缩短（MD=-38.11，95% CI=-48.61--27.61，P<0.00001），术后住院时间缩短（MD=-5.11，95% CI=-6.26--3.95，P<0.00001），术后30 d病死例数降低（OR=0.30，95% CI=0.16-0.55，P=0.0001）。结论：腔内修复治疗AAA较开腹手术具有创伤小、失血少、术后恢复快的优点，围手术期具有较大优势，但长期预后有待研究。

Endovascular versus open repair for abdominal aortic aneurysms: a Meta-analysis of perioperative efficacy

Objective: To compare the perioperative efficacy of endovascular and open repair for AAA by means of systematic review. Methods: The literature of randomized controlled trials (RCTs) comparing endovascular and open repair for AAA was collected by searching the national and international databases. Meta-analysis was performed by using Revman 5.1 software. Results: Seven randomized controlled trials with 8 reports were included, which involved a total of 2?807 patients, of whom 1 433 cases underwent endovascular repair (endovascular group) and 1 374 cases underwent open surgery (open surgery group). Results of Meta-analyses showed that in endovascular group compared with open surgery group, the operative time and volume of intraoperative blood transfusion was reduced (SMD=–0.87, 95% CI=–1.43––0.31, P=0.002; SMD=–0.83, 95% CI=–0.94––0.72, P<0.00001), the length of postoperative stay in ICU and hospital was shortened (MD=–38.11, 95% CI=–48.61––27.61, P<0.00001; MD=–5.11, 95% CI=–6.26––3.95, P<0.00001), and number of 30-day postoperative death was decreased (OR=0.30, 95% CI=0.16–0.55, P=0.0001). Conclusion: Endovascular repair has the perioperative advantages of minimal trauma, reduced blood loss and quick postoperative recovery versus open surgery, but its long term results still need further observation.