经皮入路和股动脉切开入路行主动脉腔内治疗的Meta分析

Percutaneous versus surgical cutdown in the treatment of endovascular aortic repair: a Meta-analysis

目的 系统性评价对比采用Perclose ProGlide缝合器的经皮入路主动脉血管腔内修复术(PEVAR)与传统的股动脉切开入路主动脉血管腔内修复术(SEVAR)的安全性.方法 检索Pubmed、Cochrane、中国生物医学文献数据库、中国知网、中国维普全文数据库检索、万方医学网1999年1月1日至2016年6月1日间具有可比性的关于PEVAR和SEVAR的文献,将住院时间、手术时间、术后住院时间、手术失败率以及手术并发症发生率作为评价效应的指标.采用软件Review Manager 5.3中的固定效应模型和随机效应模型对评价指标的相关数据进行合并计算分析.结果 21篇文献被纳入,其中有2篇是随机对照研究,4篇前瞻性研究,15篇回顾性研究.PEVAR与SEVAR相比,住院时间[标准化差值(SMD) =-0.44,95％置信区间CI:-0.58～-0.29,P＜0.000 01]、手术时间(SMD=-0.53,95％CI:-0.72～-0.33,P＜0.000 01)、术后住院时间(SMD=-0.36,95％CI:-0.62～-0.10,P=0.006)更短,手术并发症总发生率[比值比(OR)=0.58,95％CI:0.44～0.75,P＜0.000 1]更低,因并发症再次手术(OR=1.36,95％CI:0.73～2.54,P=0.34)的风险并没有增加.结论 采用Preclose技术的PEVAR与传统SEVAR在时间效率、减少入路相关并发症发生率等方面更有优势.

Objective This study aimed to comprehensively evaluate the safety and efficacy of total percutaneous endovascular aortic repair (PEVAR) with Perclose ProGlide devices compared with endovascular aortic repair with femoral surgical cutdown (SEVAR).Methods Pubmed,Cochrane,CBMdisc,CNKI,VIP,and Wangfang Med Online were searched from 1 January 1999 to 1 June 2016 to identify all studies providing comparative outcomes of Preclose Technology with Perclose ProGlide devices for the percutaneous endovascular aortic aneurysm repair.Hospital length of stay,operation time,postoperative hospital length of stay,success rate and access-related complications were defined as primary outcome parameters.Combined overall outcomes were calculated using fixed and randomized effects models by Review Manager 5.3.We conducted a meta-analysis using endovascular aortic repair with femoral surgical cutdown as control group.Result Twenty one studies including 2 randomized controlled trials,4 prospective studies and 15 retrospective studies were identified.Percutaneous access was associated with a shorter hospital stay (SMD=-0.44,95％CI [-0.58,-0.29],P＜0.000 01),operation time (SMD=-0.53,95％CI [-0.72,-0.33],P＜0.000 01),postoperative hospital stay (SMD=-0.36,95％CI [-0.62,-0.10],P=0.006),and lower frequency of total complications (OR=0.58,95％CI [0.44,0.75],P＜0.000 1) and reoperation due to the complications (OR=1.36,95％CI [0.73,2.54],P=0.34).Conclusion Percutaneous access with Preclose technology demonstrates advantages over conventional femoral surgical cutdown for endovascular aortic repair,as indicated by improved time efficiency and access-related complications.