摘要
目的综合评价三类主动脉弓部手术的并发症发生率、死亡率及生存率,为弓部夹层手术提供相关临床依据。方法利用计算机搜索在2004-2014年发表在Pub Med、Web of science、西文医学生物期刊三个数据库中关于主动脉夹层弓部相关手术的文献,采用MINORS条目对文献进行质量评价。相关数据通过Stata10.0统计软件进行分析处理。统计时采用并发症的发生率、生存率及95%可信区间(CI)进行结果描述。结果本Meta分析纳入文献共33篇,每篇文献病例数在21～411例之间,所有文献均采用回顾性研究。其中开放手术组7篇,支架组16篇,杂交手术组10篇。开放手术组:总NS并发症发生率为5.4%(95%CI:3.9%～7.0%);二次手术率为7.8%(95%CI:5.8%～9.7%);1年生存率为91.1%(95%CI:86.6%～95.7%);5年生存率为89.5%(95%CI:86.5%～92.6%);支架组:二次手术率为5.0%(95%CI:3.0%～7.0%);术后30d内死亡率为3.2%(95%CI:2.1%～4.2%);支架内漏发生率为64%(95%CI:5.0%～7.8%);1年生存率为91.3%(95%CI:89.4%～93.2%);5年生存率为79.1%(95%CI:76.2%～82.0%);杂交组:二次手术率为7.6%(95%CI:3.9%～11.2%);术后30d内死亡率为7.4%(95%CI:5.2%～9.7%);支架内漏率为6.9%(95%CI:4.7%～9.1%);1年生存率为84.9%(95%CI:81.6%～88.3%);5年生存率为73.9%(95%CI:68.3%～79.5%)。三类手术总的并发症发生率及生存率的合并:总NS并发症发生率为5.5%(95%CI:4.6%～6.5%);术后30d内死亡率为4.2%(95%CI:3.4%～5.0%);支架组和杂交组术后支架内漏发生率为6.5%(95%CI:5.3%-7.7%);总的1年生存率为88.8%(95%CI:86.5%～91.1%);5年生存率为79.4%(95%CI:74.4%～84.5%)。结论开放手术对夹层的治疗效果显著,有较高的远期生存率,适合年龄较轻、基础疾病少、主动脉瓣及弓部病变严重的患者。介入手术创伤小,住院时间短,早期疗效好,尤其适合高龄、基础疾病多,有足够锚定区的弓部夹层患者。杂交手术是对于高龄和多器官功能障碍而不能耐受体外循环或
Objective To discuss the occurrence of complications, the mortality and the survival rate in 3 kinds of aortic arch operations. Methods Computer screening of the relevant articles about procedures of aortic arch dissection from 2004 to2014 was made on PubMed, Web of Science and Western Medical Journals; the quality of articles was assessed by the Methodological Index for Non-Randomized Studies（MINORS）. Stata10.0 statistical software was applied in analyzing the collected data; the ratio of complications, mortality and survival rate with their corresponding 95% confidence intervals（95% CIs） are used to describe the outcomes. Results 33 articles of retrospective study were selected in this meta analysis with the case number in the articles ranging from 21 to 411： 7 of open surgical repair, 16 of TEVAR and 10 of hybrid; in the 7 of open surgical repair,total NS complications rate, reoperation rate, 1 year survival rate and 5 year survival rate was 5.4%（95%CI： 3.9%～7.0%）,7.8%（95%CI： 5.8%～9.7%）.91.1%（95%CI： 86.6%～95.7%）,and 89.5%（95%CI： 86.5%～92.6%）, respectively; in the 16 of TEVAR, reoperation rate, within-30-days mortality rate, endoleak rate, 1-year survival rate and 5-year survival rate was5.0%（95%CI： 3.0%～7.0%）,3.2%（95%CI： 2.1%～4.2%）, 6.4%（95%CI： 5.0%～7.8%）,91.3%（95%CI： 89.4%～93.2%）,and79.1%（95%CI： 76.2%～82.0%）,respectively; in the 10 of hybrid, reoperation rate, within-3 0-days mortality rate, endoleak rate, 1-year survival rate and 5-year survival rate was 7.6%（95%CI： 3.9%～11.2%）,7.4%（95% CI： 5.2%～9.7%）,6.9%（95%CI： 4.7%～9.1%）,84.9%（95%CI： 81.6%～88.3%） and 73.9%（95%CI： 68.3%～79.5%）,respectively; The total ratio of NS complications, within-30-day mortality, endoleak, total 1-year survival rate and 5-year survival rate was 5.5%（95% CI：4.6%～6.5%）,4.2%（95% CI： 3.4%～5.0%）,6.5%（95% CI： 5.3%～7.7%）, 88.8%（95% CI： 86.5%～91.1%）,and 79.4%（95% CI： 74.4%～84.5%）,res
作者
许凌
尤庆生
林雷
蔡俊锋
周黎瑾
陈龙
沈毅
Xu Ling;You Qingsheng;Lin Lei;Cai Junfeng;Zhou Lijin;Chen Long;Shen Yi(Department of Cardiac Surgery,Huadong hospitaI Affiliated to Fudan University,Shanghai,200040;Department of Cardiovascular and Thoracic Surgery,Affiliated Hospital to Nantong University,Nantong City,Jiangsu Province,226001;Statistics Department of Public Health College,Nantong University,Nantong City,Jiangsu Province,226001,P.R.China)
出处
《老年医学与保健》
CAS
2018年第4期454-460,共7页
Geriatrics & Health Care
