CAJ | 학술논문

目的：评价外科手术和介入技术（球囊或支架）治疗主动脉缩窄（ CoA）的疗效。方法计算机检索PubMed，Embase，Cochrane图书馆，中国期刊全文数据库（CNKI）及维普数据库（VIP）里的外科手术和介入技术治疗主动脉缩窄的临床对照研究。文献检索时间从建库至2013年3月。根据The Newcastle-Ot-tawa Scale（ NOS）量表评价纳入文献的质量并提取资料。对符合质量标准的对照研究采用Rev Man 5.2进行异质性检验及meta分析。结果检出相关文献816篇，根据纳入标准最终入选10篇文献；共入选病例785例。与外科组相比，介入组在术后随访期再狭窄（ OR：0.21；95％CI：0.11～0.38）、主动脉瘤形成（ OR：0.52；95％CI：0.29～0.93）及再干预（ OR：0.56；95％CI：0.35～0.89）的发生率上明显增加，差异具有统计学意义（分别P＜0.01，P＝0.03，P＝0.02）；介入组患者的住院时间明显缩短（ SMD：3.64；95％CI：2.49～4.80），差异具有统计学意义（ P＜0.01）；外科组与介入组在术后早期并发症的发生率上无明显差异，但倾向于外科组早期并发症多（ OR：2.03；95％CI：0.74～5.51；P＝0.17）。结论外科手术仍然是治疗CoA的主要方式，远期并发症和再干预率低于介入治疗；支架技术治疗成人CoA早中期效果显著，远期效果有待于进一步的随访。
목적：평개외과수술화개입기술（구낭혹지가）치료주동맥축착（ CoA）적료효。방법계산궤검색PubMed，Embase，Cochrane도서관，중국기간전문수거고（CNKI）급유보수거고（VIP）리적외과수술화개입기술치료주동맥축착적림상대조연구。문헌검색시간종건고지2013년3월。근거The Newcastle-Ot-tawa Scale（ NOS）량표평개납입문헌적질량병제취자료。대부합질량표준적대조연구채용Rev Man 5.2진행이질성검험급meta분석。결과검출상관문헌816편，근거납입표준최종입선10편문헌；공입선병례785례。여외과조상비，개입조재술후수방기재협착（ OR：0.21；95％CI：0.11～0.38）、주동맥류형성（ OR：0.52；95％CI：0.29～0.93）급재간예（ OR：0.56；95％CI：0.35～0.89）적발생솔상명현증가，차이구유통계학의의（분별P＜0.01，P＝0.03，P＝0.02）；개입조환자적주원시간명현축단（ SMD：3.64；95％CI：2.49～4.80），차이구유통계학의의（ P＜0.01）；외과조여개입조재술후조기병발증적발생솔상무명현차이，단경향우외과조조기병발증다（ OR：2.03；95％CI：0.74～5.51；P＝0.17）。결론외과수술잉연시치료CoA적주요방식，원기병발증화재간예솔저우개입치료；지가기술치료성인CoA조중기효과현저，원기효과유대우진일보적수방。
Objective To conduct a meta-analysis of the effectiveness and safety of endovascular management compared with open surgery in patients with coarctation of the aorta ( CoA ) .Methods PubMed , Embase , the Cochrane Controlled Trials Register databases , CNKI and VIP databases were searched , and study eligibility and conducted data abstraction were determined independently and in duplicate .The studies that the observational or randomized control trials comparing endovascular treatment with open surgery in CoA were included .Literature searches from database establishment to March 2013 .The heterogeneity and data were analyzed by the software of Rev Man 5.2 .Results Of 816 studies identified ,10 studies met eligibility criteria ,and included a total of 785 patients.The incidence of recoarctation(OR:0.21;95%CI:0.11-0.38),aortic aneurysm(OR:0.52;95% CI:0.29-0.93 ) and reintervention ( OR:0.56;95% CI:0.35-0.89 ) during follow-up were significantly increased respectively ( P<0.01 ,P=0.03 ,P=0.02 ,respectively ) in endovascular treatment group than in surgery group.Converse results were shown in median hospitalization time (SMD:3.64;95% CI:2.49-4.80,P<0.01). There was no significant difference in early complications ( OR:2.03;95% CI:0.74-5.51;P =0.17 ) between surgery group and endovascular group .Conclusions Surgery has proven to be and remains an effective treatment for the management of CoA ,the risk for recoarctation and aneurysm formation seems to be lower than endovascular treatment.There are excellent short-term and intermediate-term results in stent management of CoA in adult patients,still,long-term follow-up data are necessary .