三分支主动脉弓覆膜支架与孙氏手术治疗Stanford A型主动脉夹层有效性与安全性的Meta分析

The effectiveness and safety of triple-branched stent graft and Sun’s procedure for Stanford A aortic dissection:a Meta-analysis

目的:对比分析主动脉弓三分支覆膜支架手术与孙氏手术治疗Stanford A型主动脉夹层的临床效果。方法:系统检索PubMed、Embase、Web of Sicence、Cochrane Library英文数据库与万方、CNKI中文数据库,纳入建库至2020年2月对比三分支覆膜支架手术与孙氏手术重建Stanford A型夹层主动脉弓的临床研究。选取术中体外循环时间、主动脉阻断时间、深低温停循环时间、术后30 d死亡率、截瘫、脑栓塞及急性肾衰竭发生率为评价指标,采用RevMan 5.3进行Meta分析。结果:纳入8篇队列研究,共391例患者(181例三分支术,210例孙氏术)。结果显示,与孙氏手术相比,三分支覆膜支架手术体外循环时间[SMD=-37.78,95%CI:(-66.34,-10.22),P=0.007]、主动脉阻断时间[SMD=-34.33,95%CI:(-61.62,-7.04),P=0.001]、深低温停循环时间[SMD=-12.10,95%CI:(-23.47,-0.73),P=0.004]较短。术后30 d死亡率、截瘫、脑栓塞及急性肾衰竭发生率无显著差异。结论:在Stanford A型主动脉夹层手术治疗中,相比于孙氏手术,三分支主动脉弓覆膜支架重建主动脉弓的早期临床效果满意。未来需随机对照试验进一步评价其远期临床效果。

Objective:To investigate and compare total aortic arch reconstruction’s safety and effectiveness with triple-branched stent graft and Sun’s procedure for Standford A aortic dissection.Method:A systematic literature search was conducted using PubMed,EMbase,Web of Science,The Cochrane Library,CNKI,Wanfang Database up to February 2020 to identify trials and these trials were about the comparison of two surgical methods for the reconstruction of Stanford type A dissection aortic arch.The time of cardiopulmonary bypass,aortic occlusion and deep hypothermia circulatory arrest,30-day mortality,the incidence of paralysis,cerebral embolism and acute renal failure were selected as evaluation indexes.Meta-analysis was performed by RevMan 5.3.Result:Eight clinical control trials were included,involving 391 cases(181 cases with triple-branched stent graft and 210 cases with Sun’s procedure).The results showed that compared with Sun’s procedure,the triple-branched stent graft operation significantly reduced the cardiopulmonary bypass time[SMD=-37.78,95%CI:(-66.34,-10.22),P=0.007],aortic occlusion time[SMD=-34.33,95%CI:(-61.62,-7.04),P=0.001],deep hypothermic circulatory arrest time[SMD=-12.10,95%CI:(-23.47,-0.73),P=0.004],and there was no significant difference in the 30-day mortality,paralysis,cerebral embolism and acute renal failure in perioperative between the two groups.Conclusion:Compared with Sun’S procedure,total arch repair with open triple-branched stent graft placement for Stanford A aortic dissection has the same early clinical effect.However,this technique’s safety and efficacy and its long-term clinical effect need to be further verified by randomized controlled trials.