严重下肢动脉闭塞性疾病旁路移植术和腔内治疗技术的荟萃分析

Meta analysis of clinical safety and efficacy evaluation of peripheral arterial disease patients with critical limb ischemia who accepted bypass surgery or endovascular therapy

目的 评价下肢动脉旁路移植术（BSX）和下肢动脉腔内治疗技术（EVT）治疗严重下肢动脉闭塞症的疗效及安全性.方法 按系统评价的要求,检索MEDLINE （1980至2014年）、Embase （1980至2014年）、Journals@Ovid Full Text（1980至2014年）数据库,根据Cochrane系统评价方法,选择文献,提取资料,应用STATA11.2软件进行荟萃分析.结果 共纳入17项研究（3项随机对照研究,14项非随机研究）,共统计患者5 515例,BSX组2 454例,EVT组2 769例.荟萃分析结果表明,两组术后30 d死亡率差异无统计学意义（OR=1.110, P=0.523）.BSX组患者术后总体并发症（OR=2.456, P=0.003）、感染（OR=3.163, P〈0.001）、血栓形成（OR=3.069, P=0.002）的发生率明显高于EVT组,但夹层、假性动脉瘤发生率较低（OR=0.537, P=0.012）.BSX组中远期结局明显优于EVT组.BSX术后1年、3年的一期及二期通畅率优于EVT组（一期通畅率：1年, OR=1.415, P=0.008; 3年, OR=1.619, P〈0.001; 二期通畅率：1年, OR=2.156, P〈0.001; 3年, OR=2.547, P〈0.001） ,5年总体生存率也高于EVT组（OR=1.243, P=0.007）.结论 EVT在减少手术创伤、降低早期术后并发症、缩短住院时间等方面具有潜在优势.BSX在降低患者中远期死亡率、提高远期通畅率上要明显优于EVT组.

Objective To evaluate the safety and efficacy of peripheral arterial disease patients with critical limb ischemia who accepted BSX or EVT. Methods According to the requirements of systematic review, we searched MEDLINE （1980-2014）, Emabse （1980-2014）, Journals @ Ovid Full Text （1980-2014） databases, selected literature and extracted data, meta-analysis was performed through STATA11.2. Results A total of 17 studies （3 RCTs, 14 non-randomized studies） and 5 515 patients （BSX group： 2 454, EVT group： 2 769） were deemed eligible. Meta-analysis showed there were no differences between the two groups in 30-day mortality （OR=1.110, P=0.523）. However, BSX was significantly associated with increasing overall complications （OR=2.456, P=0.003）, infections （OR=3.163, P〈0.001） and thrombosis （OR=3.069, P=0.002）, but showed a reduction in dissection and pseudoaneurysm （OR=0.537, P=0.012）. During the follow-up, BSX had significant advantages. The 1-year and 3-year primary patency of BSX patients were higher than EVT group （1 year, OR=1.415, P=0.008; 3 years, OR=1.619, P〈0.001）; so were in secondary patency（ 1 year, OR=2.156, P〈0.001; 3 years, OR=2.547, P〈0.001）. Meanwhile, the 5-year overall survival rate was also higher in BSX group （OR=1.243, P=0.007）. Conclusions EVT has potential advantages in reducing surgical trauma and early postoperative complications, shortening hospital stay and so on. Concerning long-term results, BSX is better in reducing long-term mortality and improving long-term patencies than EVT group.