Zhang Hao, Wang Zhi-Wei, Zhou Zhen, Hu Xiao-Ping, Wu Hong-Bing, Guo Yi
Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.
Ann Vasc Surg. 2012 May;26(4):454-61. doi: 10.1016/j.avsg.2011.09.004. Epub 2012 Jan 27.
Acute type B aortic dissection (ATBAD) is a life-threatening condition. Open chest surgical repair using a prosthetic graft has been a conventional treatment for ATBAD. During the past decade, thoracic endovascular aortic repair (TEVAR), which is considered as a less invasive and potentially safer technique, has been increasingly used to treat this condition. Evidence is needed to support the use of TEVAR for these patients. The aim of this review was to assess the efficacy of TEVAR versus conventional open surgery in patients with ATBAD.
For this review, 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, and the Chinese Biomedicine Database for clinical trials until January 18, 2011. Controlled trials in which patients with ATBAD were assigned to TEVAR or open surgical repair were included. For each outcome, we evaluated the quality of the evidence with reference to the Grading of Recommendations Assessments, Development, and Evaluation criteria. At the end, we used RevMan 5.0 software to analyze the datum.
Five trials (318 participants) are included in this review. As determined by the Grading of Recommendations Assessments, Development, and Evaluation approach, the result quality was low for 30-day mortality and very low for other variables. TEVAR can significantly reduce the short-term mortality for ATBAD (Mantel-Haenszel fixed odds ratio [95% confidence interval]: 0.19 [0.09-0.39], P < 0.001). TEVAR cannot significantly improve postoperative complications or long-term mortality.
TEVAR can be weakly recommended as an alternative for the selective treatment of ATBAD but cannot always be used in case of surgery.
急性B型主动脉夹层（ATBAD）是一种危及生命的疾病。使用人工血管进行开胸手术修复一直是ATBAD的传统治疗方法。在过去十年中，胸主动脉腔内修复术（TEVAR）被认为是一种侵入性较小且潜在更安全的技术，越来越多地用于治疗这种疾病。需要证据来支持对这些患者使用TEVAR。本综述的目的是评估TEVAR与传统开放手术治疗ATBAD患者的疗效。
对于本综述，我们检索了Cochrane图书馆中的Cochrane对照试验中心注册库（CENTRAL）（最后检索时间：2010年第4期）、MEDLINE、EMBASE、CINAHL、科学引文索引和中国生物医学数据库，以查找截至2011年1月18日的临床试验。纳入将ATBAD患者分配接受TEVAR或开放手术修复的对照试验。对于每个结局，我们参照推荐分级评估、制定和评价标准评估证据质量。最后，我们使用RevMan 5.0软件分析数据。
本综述纳入了五项试验（318名参与者）。根据推荐分级评估、制定和评价方法确定，30天死亡率的结果质量低，其他变量的结果质量极低。TEVAR可显著降低ATBAD的短期死亡率（Mantel-Haenszel固定比值比[95%置信区间]：0.19[0.09 - 0.39]，P < 0.001）。TEVAR不能显著改善术后并发症或长期死亡率。
TEVAR可作为ATBAD选择性治疗的替代方法被弱推荐，但并非在所有手术情况下都适用。
