开放手术和腔内技术治疗复杂腹主动脉瘤的网状Meta分析

Open surgical repair versus endovascular aortic repair of complex abdominal aortic aneurysms:a network meta-analysis

目的使用网状Meta分析比较开窗技术、烟囱技术和开放手术治疗复杂腹主动脉瘤的疗效。方法计算机检索PubMed、Embase、Cochrane Library、中文期刊全文数据库和万方数据库,检索1999年1月1日至2022年2月15日发表的关于开窗技术、烟囱技术和开放手术治疗择期复杂腹主动脉瘤疗效对比的研究。运用ADDIS 1.16.6和Stata 16.0软件进行网状Meta分析。结果共纳入12篇观察性研究,共计3594例患者。网状Meta分析结果显示三种手术方式在早期再干预率、30 d死亡率、肠缺血、切口并发症、下肢缺血、卒中或脑缺血发作并发症发生率方面差异无统计学意义(均P>0.05);在心肌梗死方面,开窗技术和烟囱技术优于开放手术;对于急性肾损伤,开窗技术优于开放手术和烟囱技术(P<0.05)。结论对于择期复杂腹主动脉瘤患者,开窗技术、烟囱技术和开放手术在早期再干预率和30 d死亡率方面差异均无统计学意义,但开窗技术和烟囱技术可减少早期并发症的发生。

Objective To compare the efficacy of fenestrated endovascular aortic repair(FEVAR),chimney endovascular aortic repair(ChEVAR),and open surgical repair(OSR)of complex abdominal aortic aneurysms(cAAA)by conducting network Meta-analysis.Methods PubMed,Embase,Cochrane Library,CNKI,and Wanfang Database were searched to find studies published between January 1,1999,and February 15,2022,and compare the efficacy of FEVAR,ChEVAR,and OSR of elective cAAA.The network Meta-analysis was performed using ADDIS 1.16.6 software and STATA 16.0.software.Results A total of 12 observational studies were included in this network Meta-analysis with 3594 patients.Among the three treatments,there was no statistically significant difference in early reintervention,30-day mortality,and the incidence of bowel ischemia,wound complications,lower extremity ischemia,and stroke or cerebral ischemia(all P>0.05).OSR had a higher incidence of myocardial infarction(P<0.05);FEVAR had a lower incidence of acute kidney injury(P<0.05).Conclusion For patients with elective cAAA,there is no statistically significant difference between early reintervention and 30-day mortality among FEVAR,ChEVAR and OSR,but FEVAR and ChEVAR could reduce the incidence of early complications.