杂交手术与孙氏手术治疗A型夹层临床疗效的Meta分析

Meta-analysis of Clinical Efficacy of Hybrid Surgery and Sun’s Surgery in the Treatment of Type A Dissection

目的:探讨杂交手术与孙氏手术治疗A型夹层的临床疗效和安全性。方法:计算机检索美国国家医学图书馆(PubMed)、Cochrane图书馆(CL)、生物医学与药理文摘数据库(EMBASE数据库)、中国期刊全文数据库及万方数据库,以"杂交手术、孙氏手术、A型夹层"为检索词,检索范围为建库至2020年2月,采用STATE软件进行Meta分析。结果:共纳入11篇文献报道,2363例患者。Meta分析显示,2种手术方式在死亡率、ICU住院时间、肾相关并发症发生率方面相当(P>0.05),杂交手术组在手术时间、体外循环时间、术后住院时间、肺部、神经系统并发症发生率方面小于孙氏手术(P<0.05)。结论:杂交手术较孙氏手术能够缩短手术时间,减少术后并发症,更加减轻了患者经济负担。由于大部分文献在患者选择上存在一定的偏倚(杂交手术患者年龄更大,合并症更多),杂交手术能否提高患者生存率还需要以后更多随机对照研究证实。

Objective:To systematically assess the clinical efficacy and safety of hybrid surgery and Sun’s surgery in the treatment of type A dissection.Method:The PubMed,Embase,Cochrane library,CNKI,Wanfang were retrieved by computer.The valid data was selected and compared using STATE 12.0 software.Result:A total of 11 articles were included,with a total of 2363 patients.Meta-analysis showed that compared with Sun’s group,operation time,extracorporeal circulation time,postoperative time,lung,neurological complications were significantly lower in Hybrid group(P<0.05).There were no significant differences in Mortality rate,ICU time,and renal dialysis rate between the two groups(P>0.05).Conclusion:Hybrid surgery has many advantages compare with Sun’s surgery.Since most of the literature has a certain bias in patient selection(hybrid surgery patients are older and have more comorbidities),whether hybrid surgery can improve patient survival needs more randomized controlled studies in the future.