腹主动脉瘤开腹手术与腔内修复术围手术期情况的荟萃分析

Perioperative conditions of open surgery and endovascular repair for abdominal aortic aneurysm: a meta-analysis

目的评价国内腹主动脉瘤(AAA)开腹手术与腔内修复术围手术期情况。方法检索2000年1月—2009年1月国内临床中心以中英文公开发表的AAA开腹手术与腔内修复术围手术期情况的非随机对照(NRCs)研究文献,提取相关指标后综合分析。结果6篇NRCs资料质量评分为18.83±0.98。与开腹手术相比,腔内修复术术中失血量(WMD=-689.24 mL,95%CI为-1 077.61^-300.88,P<0.05),术中输血量(WMD=-440.01 mL,95%CI为-488.96^-391.06,P<0.05),术后禁食时间(WMD=-5.21 d,95%CI为-6.23^-4.19,P<0.05),术后ICU观察时间(WMD=-1.79 d,95%CI为-2.21^-1.46,P<0.05),术后住院时间(WMD=-5.19 d,95%CI为-7.09^-3.28,P<0.05)均显著减少。两种治疗方法的手术时间(WMD=-35.86 min,95%CI为-85.01~13.28,P=0.15)及并发症发生率(OR=0.92,95%CI为0.55~1.53,P=0.74)差异无统计学意义。结论国内NRCs资料的荟萃分析显示,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,但在手术时间及减少近期并发症方面无显著优势。

Objective To evaluate the difference in perioperative conditions of open surgery and endovascular repair for abdominal aortic aneurysm in China.Methods Articles of non-randomized comparative studies（NRCs） of open surgical repair and endovascular repair for abdominal aortic aneurysm which were published in china before January 2009 were retrieved,and correlated indexes were extracted for meta-analysis.Results The mean quality score of the 6 articles selected was 18.83±0.98.Compared with open surgical repair,the endovascular repair was associated with a significantly less amount of blood loss（WMD=-689.24 mL,95%CI：-1077.61～-300.88,P〈0.05）,less blood transfusion（WMD=-440.01 mL,95%CI：-488.96～-391.06,P〈0.05）during the operation,shorter time of fasting period（WMD=-5.21 d,95%CI：-6.23～-4.19,P〈0.05）,shorter observation period in intensive care unit（WMD=-1.79 d,95%CI：-2.21～-1.46,P〈0.05） and shorter hospital stay after operation（WMD=-5.19 d,95%CI：-7.09～-3.28,P〈0.05）.There was no statistically significant difference in operative time（WMD=-35.86 min,95%CI：-85.01～13.28,P=0.15） or complication rate（OR=0.92,95%CI：0.55～1.53,P=0.74）between the two groups.Conclusions The results of meta-analysis show that endovascular repair has the advantage of mild trauma,less blood loss and quicker recovery after operation.But there was no significant difference in operative time and complication rate between the two groups.