中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2011年
10期
588-593
,共6页
张浩%王志维%郭毅%戴小峰%赵磊%吴红兵%胡小平
張浩%王誌維%郭毅%戴小峰%趙磊%吳紅兵%鬍小平
장호%왕지유%곽의%대소봉%조뢰%오홍병%호소평
动脉瘤,夹层%心脏外科手术%Meta分析%覆膜支架置入术
動脈瘤,夾層%心髒外科手術%Meta分析%覆膜支架置入術
동맥류,협층%심장외과수술%Meta분석%복막지가치입술
Aneurysm,dissecting%Cardiac surgical procedures%Meta-analysis%Stent
目的 评价主动脉腔内覆膜支架置入术(支架置入术)与开放手术治疗急性B犁胸主动脉夹层(acute type B aortic dissection,ATBAD)的疗效.方法 系统检索Cochrane图书馆的临床对照试验中心注册库(Cochrane Central Register of Controlled Trials,CENTRAL)、MEDLINE、EMBASE、CINAHL、Web of Science、OpenSIGLE、National Technical Information Service(NTIS)和中国知网(CNKI)、中国生物文献数据库(CBM)、维普数据库(VIP)、万方数据库(WanFang Data)里的主动脉腔内覆膜支架置入术和开放手术治疗急性B型主动脉夹层的临床对照试验.文献检索起止时间均为从建库到201 1年1月18日.由研究人员根据Cochrane偏倚评价和GRADE系统推荐分级方法,对证据质量进行严格评价和资料提取,对符合质量标准的临床对照试验进行meta分析.统计学分析采用RevMan 5.0软件和GRAED profiler 3.2.2软件.结果 5个临床试验共318例患者纳入研究.GRADE评价分析发现30天病死率的证据质量是低级,其他结局均为极低级.急性B型主动脉夹层患者主动脉腔内覆膜支架置入术组与手术组治疗的短期病死率差异有统计学意义,OR 0.19、95% CI [0.09,0.39],P<0.001,但围术期并发症和远期病死率两组比较差异无统计学意义,OR 1.40、95% CI [0.24,8.18].结论 主动脉腔内覆膜支架置入术只能作为治疗急性B型主动脉夹层的一种选择,目前的证据尚不能证明其可完全替代开放手术.
目的 評價主動脈腔內覆膜支架置入術(支架置入術)與開放手術治療急性B犛胸主動脈夾層(acute type B aortic dissection,ATBAD)的療效.方法 繫統檢索Cochrane圖書館的臨床對照試驗中心註冊庫(Cochrane Central Register of Controlled Trials,CENTRAL)、MEDLINE、EMBASE、CINAHL、Web of Science、OpenSIGLE、National Technical Information Service(NTIS)和中國知網(CNKI)、中國生物文獻數據庫(CBM)、維普數據庫(VIP)、萬方數據庫(WanFang Data)裏的主動脈腔內覆膜支架置入術和開放手術治療急性B型主動脈夾層的臨床對照試驗.文獻檢索起止時間均為從建庫到201 1年1月18日.由研究人員根據Cochrane偏倚評價和GRADE繫統推薦分級方法,對證據質量進行嚴格評價和資料提取,對符閤質量標準的臨床對照試驗進行meta分析.統計學分析採用RevMan 5.0軟件和GRAED profiler 3.2.2軟件.結果 5箇臨床試驗共318例患者納入研究.GRADE評價分析髮現30天病死率的證據質量是低級,其他結跼均為極低級.急性B型主動脈夾層患者主動脈腔內覆膜支架置入術組與手術組治療的短期病死率差異有統計學意義,OR 0.19、95% CI [0.09,0.39],P<0.001,但圍術期併髮癥和遠期病死率兩組比較差異無統計學意義,OR 1.40、95% CI [0.24,8.18].結論 主動脈腔內覆膜支架置入術隻能作為治療急性B型主動脈夾層的一種選擇,目前的證據尚不能證明其可完全替代開放手術.
목적 평개주동맥강내복막지가치입술(지가치입술)여개방수술치료급성B리흉주동맥협층(acute type B aortic dissection,ATBAD)적료효.방법 계통검색Cochrane도서관적림상대조시험중심주책고(Cochrane Central Register of Controlled Trials,CENTRAL)、MEDLINE、EMBASE、CINAHL、Web of Science、OpenSIGLE、National Technical Information Service(NTIS)화중국지망(CNKI)、중국생물문헌수거고(CBM)、유보수거고(VIP)、만방수거고(WanFang Data)리적주동맥강내복막지가치입술화개방수술치료급성B형주동맥협층적림상대조시험.문헌검색기지시간균위종건고도201 1년1월18일.유연구인원근거Cochrane편의평개화GRADE계통추천분급방법,대증거질량진행엄격평개화자료제취,대부합질량표준적림상대조시험진행meta분석.통계학분석채용RevMan 5.0연건화GRAED profiler 3.2.2연건.결과 5개림상시험공318례환자납입연구.GRADE평개분석발현30천병사솔적증거질량시저급,기타결국균위겁저급.급성B형주동맥협층환자주동맥강내복막지가치입술조여수술조치료적단기병사솔차이유통계학의의,OR 0.19、95% CI [0.09,0.39],P<0.001,단위술기병발증화원기병사솔량조비교차이무통계학의의,OR 1.40、95% CI [0.24,8.18].결론 주동맥강내복막지가치입술지능작위치료급성B형주동맥협층적일충선택,목전적증거상불능증명기가완전체대개방수술.
Objective Acute type B aortic dissection (ATBAD) is a life-threatening condition.Open surgical (OS) repair with a prosthetic graft has been a conventional treatment for ATBAD.Thoracic endovascular aortic repair (TEVAR),as a less invasive and potentially safer technique,has been used increasingly in recent decade.Evidence to support the use of TEVARin these patients is needed.This meta-analysis was to assess the efficacy of TEVAR versus conventional OS in patients with ATBAD.Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2010,Issue 4),MEDLINE,EMBASE,CINAHL,Web of Science 、OpenSIGLE 、National Technical Information Service(NTIS) 、CNKI 、Chinese Biomedicine Database 、VIP、WanFang Data for clinical trials and additional sources for published and unpublished trials until 1/18/2011.Controlled trials in which patients with ATBAD were assigned to TEVAR or OS repair were included.The authors extracted independently the following information using a specifically designed data collection form for individual trial included:first author and the year of publication,study population,interventions used (TEVAR or OS repair) and outcomes (short-term mortality,short-term complications,long-term complications and long-term mortality rates).Data were extracted on the relevant methodological domains to minimize the bias in the analysis with use of the Cochrane methods for bias assessment and Grading of Recommendations Assessments Development and Evaluation (GRADE)methods.For each outcome,GRADE criteria and Cochrane Bias evaluation were used to evaluate the quality of the evidence with regard to inconsistency (heterogeneity),indirectness,imprecision,and other potential sources of bias,such as publication and reporting bias.Revman5.0 and GRAED profiler 3.2.2 software were used to analyze the data.Results Five trials (318 participants) were included in the analysis.The five studies were limited by lack of allocation concealment and blindness,and the studies were small.The evidence quality determined with the GRADE approach for 30-day mortality was poor and for other variables was very poor.As compared with ATBAD,TEVAR associated with a significantly reduced short-term mortality,M-H fixed odds ratio 0.19,95% CI [0.09,0.39],P<0.001.However,TEVAR could not improve the postoperative outcomes such as complications or long-term mortality,M-H random odds ratio 1.40,95% CI[0.24,8.18].Conclusion TEVAR can be weakly recommended as an alternative for the treatment of ATBAD in selected cases and may not be used as a general option in place of surgery based on the current evidences.