腹主动脉瘤腔内修复术治疗肾下腹主动脉瘤的效果及安全性的Meta分析

Meta Analysis on Effectiveness and Safety of Endovascular Repair for Abdominal Aortic Aneurysm in Treatment of Infrarenal Abdominal Aortic Aneurysm

目的:系统评价腹主动脉瘤腔内修复术(EVAR)与开腹手术治疗肾下腹主动脉瘤(AAA)的效果及安全性。方法:计算机检索相关数据库查找有关EVAR与传统开腹手术治疗AAA的随机对照试验,检索时间均为建库至2020年6月。对数据采用RevMan 5.2软件进行Meta分析。结果:最终纳入9篇文献,EVAR组术后30 d全因死亡率、中期动脉瘤相关死亡率低于开腹手术组,手术中期再次手术率高于开腹手术组(P<0.0001);EVAR组与开腹手术组中期全因死亡率、总并发症发生率及手术相关并发症发生率比较,差异无统计学意义(P>0.05)。结论:EVAR治疗肾下AAA的30 d全因死亡率和动脉瘤相关死亡率均低于开腹手术;两者中期全因死亡率、总并发症发生率及手术相关并发症发生率相似,而EVAR治疗的中期再次手术率高于开腹手术治疗,表明EVAR治疗肾动脉下非破裂型AAA的短期疗效肯定,但发生再次手术危险性较高,导致EVAR总体获益不确定。

Objective:To systemically evaluate the effectiveness and safety of endovascular aneurysm repair(EVAR)and laparotomy in treatment of infrarenal abdominal aortic aneurysm(AAA).Methods:Computer-based database retrievals were performed for randomized controlled trials of EVAR versus conventional laparotomy for AAA,the retrieval period was from the establishment of these databases to June 2020.Meta analysis of data was performed using RevMan 5.2 software.Results:Nine literatures were finally included,and the all-cause mortality and mid-term aneurysm-related mortality in the EVAR group were lower than those in the laparotomy group,and the reoperation rate in the mid-term of surgery was higher than that in the laparotomy group(P<0.0001).There were no significant differences in mid-term all-cause mortality,total complication rate and surgery-related complication rate between EVAR group and laparotomy group(P>0.05).Conclusion:The 30-day all-cause mortality and aneurysm-related mortality of EVAR in the treatment of infrarenal AAA are lower than those of laparotomy.The mid-term all-cause mortality,total complication rate and surgery-related complication rate are similar between two groups,while the mid-term reoperation rate of EVAR treatment is higher than that of laparotomy,indicating that the short-term efficacy of EVAR in the treatment of non-ruptured infrarenal AAA is accurate,but the risk of reoperation is high,resulting in uncertain overall benefit of EVAR.