开窗技术和烟囱技术治疗复杂瘤颈腹主动脉瘤的Meta分析

Meta-analysis of fenestrated endovascular aneurysm repair versus chimney endovascular aneurysm repair for abdominal aortic aneurysm with complex aneurysm necks

目的比较开窗技术和烟囱技术治疗复杂瘤颈腹主动脉瘤的安全性和有效性。方法系统性检索PubMed、EMbase、Cochrane、万方数据、中国生物医学文献数据库和中国知网等数据库,收集开窗技术及腔内烟囱技术治疗复杂瘤颈腹主动脉瘤的随机或非随机同期对照试验,检索时限截止至2019年11月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan5.1软件进行Meta分析。结果共纳入9项非随机对照试验研究,共536例患者,其中315例行开窗技术治疗,221例行烟囱技术治疗。Meta分析结果显示,手术有效性方面,开窗技术组比烟囱技术组Ⅰ型内漏的发生率低,差异有统计学意义(OR=0.31,95%CI=0.12~0.85,P=0.02);两组在技术成功率、血管再狭窄率、再干预率方面差异无统计学意义。手术安全性方面,烟囱技术组较开窗技术组出现靶器官受损的发生率低,差异有统计学意义(OR=2.96,95%CI=1.30~6.72,P=0.01);两组在术后30 d死亡率方面差异无统计学意义。结论开窗技术和烟囱技术均为治疗复杂瘤颈腹主动脉瘤的安全和有效方法,开窗技术和烟囱技术相比,发生Ⅰ型内漏较低,但靶器官受损较高。

Objective To compare the effectiveness and safety of fenestrated endovascular aneurysm repair(F-EVAR)and chimney endovascular aneurysm repair(Ch-EVAR)for abdominal aortic aneurysm with complex aneurysm necks.Methods We systematically searched Databases including PubMed,EMbase,the Cochrane database,Wanfang Data,China Biology Medicine disc and China National Knowledge Infrastructure to collect the RCTs and non-RCTs about F-EVAR versus Ch-EVAR for abdominal aortic aneurysm with complex aneurysm neck.The retrieval time was from inception to November 2019.The studies were screened according to the inclusion and exclusion criteria,the data were extracted and the quality was evaluated by two reviewers independently.Then meta-analysis was conducted with RevMan 5.1 software.Results A total of 9 non-RCTs involving 536 patients were included.The results of meta-analysis showed that:1)Related to the post-operation effectiveness,F-EVAR had lower incidence of typeⅠendoleak than Ch-EVAR(OR=0.31,95%CI=0.12~0.85,P=0.02).There was no statistically significant difference in technical success rate,restenosis rate and reintervention rate between two groups.2)Related to the post-operation safety,Ch-EVAR had lower presence of target organ injury than F-EVAR(OR=2.96,95%CI=1.30~6.72,P=0.01).There was no statistically significant difference in 30-day mortality between two groups.Conclusion Both F-EVAR and Ch-EVAR are safe and effective treatments for abdominal aortic aneurysm with complex aneurysm neck.Compared with Ch-EVAR,F-EVAR has relative low incidence of typeⅠendoleak and relatively high prevalence of target organ injury.