主动脉疾病专题研究(Monographic Study of Aortic Diseases)

小直径腹主动脉瘤手术治疗和保守治疗疗效的Meta 分析

Published at: 2015年第24卷第6期

张显岚 1 , 郭建刚 1
1 桂林医学院附属医院 血管、乳腺外科,广西 桂林 541001
通讯作者 显岚 张 Email: zhangxianlan1962@126.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.06.005
基金:

摘要

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

Abstract

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.


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引用

引用本文: 显岚 张, 建刚 郭. 小直径腹主动脉瘤手术治疗和保守治疗疗效的Meta 分析[J]. 中国普通外科杂志, 2015, 24(6): 792-799.
Cite this article as: ZHANG Xianlan, GUO Jiangang . Surgical versus conservative treatment for small-diameter abdominal aortic aneurysm: a meta-analysis[J]. Chin J Gen Surg, 2015, 24(6): 792-799.