B型主动脉夹层腔内修复治疗的荟萃分析

Endovascular stent-graft therapy for type B aortic dissection:a meta-analysis

目的分析B型主动脉夹层腔内修复治疗的技术成功率、轻微并发症、严重并发症、脑卒中、截瘫等的发生率。方法系统收集1999年至2009年Medline收录的有关B型主动脉夹层腔内修复治疗文献,通过制定纳入和排除标准,对所得数据进行汇总分析。结果在收录的12篇文献中,共有病例数761例,B型主动脉夹层腔内修复治疗的技术成功率为97.66%,轻微并发症为17.44%,严重并发症为4.02%;脑卒中为1.29%,截瘫为1.30%,30 d内病死率为3.55%。随访期内病死率为4.08%,平均随访时间为12～48.3个月。结论腔内修复治疗技术可行,并发症较少,目前已成为B型主动脉夹层治疗的首选。但因随访时间相对较短,且缺乏随机对照研究,故与其他方法治疗间的差异是否有统计学意义有待进一步研究。

Objective To analyze the technique success rate of endovascular stent-graft therapy in treating type B aortic dissection and to discuss the occurrence of both mild and severe complications including stroke, paraplegia, etc, Methods The medical documents concerning endovascular stent-graft therapy for type B aortic dissection published from 1999 to 2009 were searched for through Medline. A total of 12 academic papers with 761 cases were collected. After making inclusion and exclusion criteria, the data obtained from the literature were analyzed. Results The analysis of all the available data showed that the technical success rate of endovascular stent-graft therapy for type B aortic dissection was 97.66%. The occurrence of minor complications, sever complications, stroke and paraplegia was 17.44%, 4.02%, 1.29% and 1.30%, respectively. The mortality was 3.55% within 30 days, and it was 4.08% during follow-up period （ranging from 12 months to 48.3 months）. The occurrence of aortic rupture or retrograde aortic dissection formation in follow-up period was 3.06%. Conclusion Endovascular stent-graft therapy for type B aortic dissection is technically feasible with fewer complications, nowadays it becomes the treatment of first choice. Nevertheless, as the follow-up time is rather short and the randomly controlled studies are lack, whether or not this technique carries statistically significant difference in therapeutic results when compared to other treatments needs to be further studied （J Intervent Radiol, 2011, 20： 530-533）