经股动脉介入诊疗术后应用血管缝合器安全性的系统评价及Meta分析

Systematic Review and Meta-analysis on the Safety of Vascular Stapler Application after Diagnosis and Treatment via Transfemoral Artery Intervention

目的系统评价经股动脉穿刺介入诊疗术后应用血管缝合器的安全性。方法计算机检索Cochrane Library、PubMed、Embase、Web of Science、EBSCO、SinoMed、中国知网(CNKI)、万方数据库、维普数据库公开发表的中、英文有关经股动脉穿刺介入诊疗术后应用血管缝合器的随机对照试验或类实验性研究,检索时间为2010年1月—2018年9月。按纳入标准和排除标准筛选文献、提取资料,系统评价文献,参照Cochrane Handbook(5.1.0)评价偏倚风险的方法评价文献的研究质量,采用Revman 5.3软件进行Meta分析。结果共纳入3项随机对照研究,6项类实验性研究。Meta分析结果显示,与常规压迫止血方法比较,应用血管缝合器进行介入诊疗术后止血,可降低皮下血肿、假性动脉瘤、腹股沟出血的发生率,差异均有统计学意义(P<0.05)。但在降低动静脉瘘、腹膜后出血、穿刺部位感染的发生率上,与常规压迫止血相比,差异无统计学意义(P>0.05)。结论血管缝合器与常规压迫止血相比,在预防经股动脉穿刺介入诊疗术后血管并发症是安全、有效的,能降低部分血管并发症的发生率。

Objective To systematically review the safety of vascular stapler after diagnosis and treatment via transfemoral artery puncture intervention.Methods The Chinese and English versions of randomized controlled trials or quasi-experimental studies on vascular stapler application after diagnosis and treatment via transfemoral artery puncture intervention published in the Cochrane Library,PubMed,Embase,Web of Science,EBSCO,SinoMed,CNKI,Wanfang database from January 2010 to September 2018 were retrieved by computer.According to the inclusion criteria and exclusion criteria,the literatures were screened,the data were extracted,and the literatures were systematically reviewed while the study quality of the literatures was evaluated by referring to the assessment method specified in Cochrane Handbook(5.1.0)for bias risk,and Revman 5.3 software was used for analysis.Results A total of 3 randomized controlled studies and 6 quasi-experimental studies were included.The results of meta-analysis showed that compared with conventional hemostasis by compression,the application of vascular stapler for hemostasis after interventional diagnosis and treatment can reduce the incidence of subcutaneous hematoma,pseudoaneurysm and inguinal hemorrhage,and all the differences were statistically significant(P<0.05).However,there was no significant difference in reducing the incidence of arterio-venous fistula,retroperitoneal hemorrhage and infection of puncture site compared with conventional hemostasis by compression(P>0.05).Conclusion Compared with conventional hemostasis by compression,vascular stapler is safe and effective in preventing vascular complications after diagnosis and treatment via transfemoral artery puncture intervention,and can reduce the incidence of some vascular complications.