腔内支架植入术治疗国内Stanford B型主动脉夹层的系统评价

Endovascular stent-graft placement for the treatment of Stanford type B aortic dissection in China: A systematic review

目的探讨国内腔内支架植入术治疗Stanford B型主动脉夹层(aortic dissection,AD)的治疗效果,技术可行性及临床安全性。方法系统检索Pub Med,科学网(Web of Science,WOS)和Cochrane图书馆中的来源于国内英文医学文献及中国生物医学数据库(Chinese Biomedical Database,CBMdisc),中国知网(China National Knowledge Infrastructure,CNKI)和万方数据库中的中文医学文献。本系统评价是基于所有评估腔内支架植入术治疗中国Stanford B型AD的治疗效果的回顾性研究。结果共有153篇回顾性研究,8 415例B型夹层患者纳入本研究。技术成功率为(99.7±0.1)%。总体并发症发生率为(19.1±0.6)%。术后内漏发生率为(7.2±0.3)%。严重并发症发生率为(3.2±0.2)%,其中神经系统并发症发生率为(1.3±0.1)%。围手术期中风率比截瘫率高(0.8%±0.1%vs0.1%±0.04%)。总体并发症发生率第1代覆膜支架比第2代覆膜支架高(25.1%±1.2%vs 9.5%±0.9%,P<0.001)。住院死亡率为(1.6±0.1)%。此外,平均随访时间为(29.4±13.5)个月,随访期间晚期死亡率为(1.8±0.2)%。30 d,6个月,1年,2年和5年总体生存率的Kaplan-Meier估计分别是(99.0±0.1)%,(98.5±0.2)%,(98.4±0.2)%,(98.1±0.2)%和(97.9±0.2)%。结论腔内支架植入术治疗Stanford B型AD切实可行,技术成功率较高,神经系统并发症发生率较低,生存率较高。第2代覆膜支架住院和随访期的治疗效果更好。

Objective To summarize the efficacy, technique feasibility, and clinical safety of endovascular repair for Stanford type Baortic dissection(AD) in China. Methods We comprehensively searched the English-language medicalliterature in Pub Med, Web of Science, and the Cochrane Library and the Chinese-language medical literatures in CBMdisc(Chinese Biomedical Database), CNKI(China National Knowledge Infrastructure), and Wanfang Data. This systematic review was based on all retrospective studies assessing outcomes of Stanford type BAD treated with endovascular stent-graft placement in China. Results A total of 153 retrospective studies that included 8 415 cases of type B AD were analyzed in this study. Procedure success was reported in(99.7±0.1)% of patients. Overall complications were reported in(19.1±0.6)% of patients. Postoperative endoleak occurred in(7.2±0.3)% of patients. Major complications were reported in(3.2±0.2)% of patients, with a neurological complication rate of(1.3±0.1)%. Periprocedural stroke occurred more frequently than paraplegia(0.8%±0.1% versus 0.1%±0.04%). Overall complications was significantly greater in patients treated with first-generation stents compared with second-generation stents(25.1%±1.2% versus 9.5%±0.9%, P<0.001). The in-hospital mortality rate was(1.6±0.1)%. Additionally,(1.8±0.2)% of patients died during a mean follow-up period of(29.4±13.5) months. The Kaplan-Meier estimates of the overall survival rate were(99.0±0.1)% at 30 days,(98.5±0.2)% at 6 months,(98.4±0.2)% at 1 year,(98.1±0.2)% at 2 years, and(97.9±0.2)% at 5 years. Conclusions Endovascular stent-graft placement is feasible and has a high technique success rate and favorable neurological complication and survival rates in treating Stanford type B AD. Technique improvements in stent-graft design and device delivery catheters have attempted to address previously encountered difficulties. The second-generation of stent-grafts has better in-hospital and follow-up outcomes.