目的：系统评价手术治疗与保守治疗对小直径腹主动脉瘤（AAA）的疗效。方法：检索国内外文献数据库，选择手术治疗（血管腔内修补术和开放手术）与保守治疗小直径AAA的随机对照实验，按照Cochrance 系统评价员手册对纳入文献的方法学质量进行评价后，采用RevMan5.1 软件进行Meta 分析。结果：共纳入4 个随机试验，4 篇文献，共计3 314 例患者，其中行血管腔内修补术和开放手术1 680 例，保守治疗1 634 例。Meta 分析结果显示，两组之间总原因病死率（SMD=0.97，95% CI=0.68~1.38）、动脉瘤相关病死率（SMD=0.81，95% CI=0.56~1.17）、动脉瘤破裂率（SMD=0.49，95% CI=0.09~2.54，P=0.39）、术后30 d 或者住院期间病死率（SMD=0.88，95% CI=0.60~1.291）差异均无统计学意义（均P>0.05）。结论：小直径AAA 手术治疗与保守治疗疗效相似，但不能确定该结论是否有临床意义，笔者经综合分析认为小直径AAA 仍应积极手术治疗。
Surgical versus conservative treatment for small-diameter abdominal aortic aneurysm: a meta-analysis
Objective: To systematically evaluate the efficacy of surgical and conservative treatment for small-diameter abdominal aortic aneurysm (AAA). Methods: The randomized controlled trails (RCTs) comparing surgical (endovascular aortic repair and open surgery) and conservative treatment for small-diameter AAA were collected by searching the national and international databases. After assessment of methodological quality of the included studies according to the Cochrane Reviewers’ Handbook criteria, Meta-analysis was performed by using RevMan 5.1 software. Results: Four RCTs were finally included, with a total of 3 314 patients, of whom 1 680 cases underwent surgical treatment and 1 634 cases underwent conservative treatment. Results of Meta-analyses showed no significance difference between the two groups of patients in all-cause mortality (SMD=0.97, 95% CI=0.68–1.38), aneurysmrelated mortality (SMD=0.81, 95% CI=0.56–1.17), incidence of aneurysm rupture (SMD=0.49, 95% CI=0.09–2.54) and mortality within postoperative 30 d or during hospitalization (SMD=0.88, 95% CI=0.60–1.29) (all P>0.05). Conclusion: In treatment of small-diameter AAA, the outcomes between surgery and conservative treatment are similar. However, the clinical significance of this conclusion is uncertain, and the authors based on comprehensive analysis deem that small-diameter AAA still needs aggressive surgical treatment.