Lin Hui-Han, Liao Shou-Fu, Wu Ching-Feng, Li Ping-Chun, Li Ming-Li
From the Division of Cardiovascular Surgery (HHL, CFW, PCL, MLL), China Medical University Hospital, Taichung; and Department of Surgery (SFL), National Taiwan University Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2015 Apr;94(16):e694. doi: 10.1097/MD.0000000000000694.
Acute aortic dissections of Stanford type A require emergency surgery repair and present challenges to surgeons. The frozen elephant technique is one of several approaches used to treat aortic arch dissection. The purpose of this meta-analysis was to investigate the clinical effectiveness of the frozen elephant technique for treating acute type A aortic dissection.Medline, Cochrane, Google Scholar, and ClinicalTrials.gov databases were searched up to March 31, 2014, for studies that assessed the use of frozen elephant trunk technique for treating acute type A aortic dissection. The primary outcome was in-hospital mortality. Secondary outcomes included rate of stroke, spinal cord injury, renal failure, and reoperations for bleeding.Eleven studies were included in the analysis that encompassed 881 patients. The mean age ranged from 45.4 to 66.8 years, and the proportion of the population that was male ranged from 45 to 85%. The overall in-hospital mortality rate was 8%. The rate of stroke, spinal cord injury, renal failure, and frequency of reoperations for bleeding were 3, 4, 5, and 5, respectively. Sensitivity analysis indicates that the findings are robust and there was no publication bias.These findings indicate that the frozen elephant techniques does not bring unacceptable mortality or morbidity risk for treating acute type A aortic dissection.
斯坦福A型急性主动脉夹层需要紧急手术修复，对外科医生来说是一项挑战。“冰冻象鼻”技术是用于治疗主动脉弓夹层的几种方法之一。本荟萃分析的目的是研究“冰冻象鼻”技术治疗急性A型主动脉夹层的临床效果。截至2014年3月31日，对Medline、Cochrane、谷歌学术和ClinicalTrials.gov数据库进行了检索，以查找评估“冰冻象鼻”技术治疗急性A型主动脉夹层应用情况的研究。主要结局是住院死亡率。次要结局包括中风、脊髓损伤、肾衰竭发生率以及因出血进行再次手术的情况。分析纳入了11项研究，共881例患者。平均年龄在45.4至66.8岁之间，男性占比在45%至85%之间。总体住院死亡率为8%。中风、脊髓损伤、肾衰竭发生率以及因出血进行再次手术的频率分别为3%、4%、5%和5%。敏感性分析表明研究结果可靠，且不存在发表偏倚。这些结果表明，“冰冻象鼻”技术治疗急性A型主动脉夹层不会带来不可接受的死亡或发病风险。
