AngioJet机械吸栓与单纯置管溶栓治疗下肢深静脉血栓形成的Meta分析

Meta-analysis of AngioJet mechanical thrombectomy versus catheter-directed thrombolysis in the treatment of deep venous thrombosis of lower extremities

目的比较单独使用AngioJet机械性血栓清除或AngioJet联合CDT与单纯CDT治疗下肢深静脉血栓形成的疗效和安全性。方法系统性检索中国知网、万方数据、PubMed、Ovid Embase和Cochrane Library等数据库建库以来发表的相关中英文文献,检索时间截止到2020年7月。两个独立的研究员交叉筛选出符合要求的文献,用RevMan 5.3软件对血栓清除率、双下肢髌骨上缘上方15 cm周径差、尿激酶用量、溶栓时间、总出血、肺栓塞、血红蛋白尿共7个指标进行Meta分析。结果共纳入文献9篇,共565例患者,其中AngioJet或AngioJet联合CDT治疗(试验组)286例,CDT治疗(对照组)279例。Meta分析结果显示,试验组血栓清除率更高、激酶用量更少、溶栓时间更短、出血风险更低,但术后出现血红蛋白尿的患者显著增多(P均<0.05),而两组膝上15 cm腿围减轻程度和肺栓塞差异无统计学意义(P>0.05)。亚组分析结果显示,两组患者轻度出血差异无统计学意义(P>0.05),而试验组重度出血更少,差异有统计学意义(P<0.05)。结论AngioJet或AngioJet联合CDT治疗下肢深静脉血栓形成有一定的优势,但对于肾功能不全或存在血管内溶血高风险的患者应慎重。

Objective To compare the efficacy and safety of AngioJet mechanical thrombectomy or AngioJet combined with CDT versus CDT in the treatment of deep vein thrombosis of lower extremities.Methods We Systematically searched databases such as CNKI,Wanfang Data,PubMed,Ovid Embase and Cochrane Library to collect relevant Chinese and English literatures published since the establishment of the database.The retrieval time was July 2020.Two independent researchers cross-screened the literatures that met the requirements.RevMan 5.3 was used to evaluate seven indicators including thrombus clearance rate,15 cm circumference difference above the upper border of the patella of both lower limbs,dosage of urokinase,thrombolysis time,total bleeding,pulmonary embolism and hemoglobinuria.Results A total of 9 literatures involving 565 patients were included,with 286 cases performed by AngioJet mechanical thrombectomy or AngioJet combined with CDT(experimental group)and 279 cases performed by CDT group(control group).Meta-analysis showed that the experimental group had higher thrombus clearance rate,less urokinase dosage,shorter thrombolytic time,and lower bleeding risk,but the postoperative hemoglobinuria increased significantly(P<0.05).There was no difference in the degree of reduction of the 15 cm leg circumference and pulmonary embolism between the two groups(P>0.05).The results of subgroup analysis showed that there was no significant difference in minor bleeding between the two groups(P>0.05),and the experimental group had less major bleeding severe bleeding,the difference was statistically significant(P<0.05).Conclusion AngioJet or AngioJet combined with CDT have certain advantages in the treatment of deep vein thrombosis of the lower extremities.However,it should be particularly cautious for patients with renal insufficiency or high risk of intravascular hemolysis.