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A New Murine Model of Endovascular Aortic Aneurysm Repair
Published on: July 7, 2013
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腹腔镜与腹腔大动脉动脉瘤的内血管动脉瘤修复相比:一个系统的审查
Bea Duric1,2, Ioannis Hadjihannas1, Sveta Sugumaran1
1Department of Laparoscopic Surgery and Surgical Skills, Barts Cancer Institute, Queen Mary University of London, London, UK.
概括
腹腔大动脉动脉瘤 (AAA) 的最小侵入性手术显示出不同的结果. 整体腹腔镜手术 (TLS) 与内血管动脉瘤修复 (EVAR) 相比,重新干预和转化率更高.
科学领域:
- 血管外科 血管外科
- 最少侵入性手术的方法
- 手术结果研究研究.
背景情况:
- 最少侵入性手术 (MIS) 为非破裂的腹腔大动脉动脉瘤 (AAA) 提供了开放修复的替代方案.
- 关键的MIS技术包括手术辅助腹腔镜手术 (HALS),全腹腔镜手术 (TLS) 和内血管动脉瘤修复 (EVAR).
- 这些MIS方法的比较结果数据对于临床决策至关重要.
研究的目的:
- 为了比较HALS,TLS和EVAR用于选择性AAA修复的临床结果.
- 评估主要结果,如死亡率和重新干预率.
- 评估二次结果,包括手术持续时间,血液损失和住院时间.
主要方法:
- 在MEDLINE,Embase,Web of Science,Google Scholar和Cochrane图书馆 (2023年1月至3月) 的系统文献搜索.
- 包括队列研究和随机对照试验 (RCT),比较两个MIS技术.
- 分析了来自8个队列研究和1个RCT的数据,涉及500名 (HALS),263名 (TLS) 和438名 (EVAR) 患者.
主要成果:
- 整体腹腔镜手术 (TLS) 显示了显著更高的30天再干预率 (p=0.00056) 和转换为开放手术的比率 (p<0.001).
- 此外,TLS的手术持续时间更长 (p=0.0311) 以及血液流失,输血量和ICU停留增加的趋势.
- 在亚组分析中,内血管动脉瘤修复 (EVAR) 与TLS相比显示出更好的结果;LAS和EVAR都有可比的死亡率.
结论:
- 腹腔镜手术 (LAS),特别是TLS,在术内转换和30天的AAA修复重新干预方面,效果不如EVAR.
- 根据目前的证据,Evar似乎是一个更有利的最小侵入性选择.
- 进一步的大规模对照试验是有必要的,以巩固这些发现.
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