• 新疆醫(yī)科大學(xué)第一附屬醫(yī)院血管甲狀腺外科（新疆烏魯木齊 830054）;

目的 　系統(tǒng)評(píng)價(jià)腔內(nèi)修復(fù)術(shù)（覆膜支架置入術(shù)）與開放手術(shù)治療急性Stanford B型主動(dòng)脈夾層的有效性與安全性。
方法 　計(jì)算機(jī)檢索1991年1月至2013年1月期間收錄在CNKI、萬方、維普、Cochrane 圖書館臨床對照試驗(yàn)中心注冊庫、OVID、Pubmed Medline、EBSCO、EMBASE、Springer Link、Science Direct等數(shù)據(jù)庫中關(guān)于主動(dòng)脈腔內(nèi)修復(fù)術(shù)和開放手術(shù)治療急性Stanford B型主動(dòng)脈夾層的臨床對照試驗(yàn)文獻(xiàn)，用RevMan 5.1軟件對符合標(biāo)準(zhǔn)的臨床試驗(yàn)數(shù)據(jù)進(jìn)行分析。
結(jié)果 　8個(gè)臨床試驗(yàn)共納入5 618例急性B型主動(dòng)脈夾層患者，腔內(nèi)修復(fù)術(shù)組與開放手術(shù)組治療后30d死亡率差異有統(tǒng)計(jì)學(xué)意義，腔內(nèi)修復(fù)組明顯優(yōu)于開放手術(shù)組 〔OR=0.55，95% CI （0.46～0.65），P＜0.000 01〕。另外，中風(fēng) 〔OR=0.57，95% CI （0.39～0.84），P=0.005〕、呼吸衰竭 〔OR=0.64，95% CI （0.53～0.78），P＜0.000 01〕 和心臟并發(fā)癥 〔OR=0.49，95% CI （0.38～0.64），P＜0.000 01〕的發(fā)生率差異均有統(tǒng)計(jì)學(xué)意義，腔內(nèi)修復(fù)組優(yōu)于開放手術(shù)組；截癱〔OR=1.30，95% CI （0.82～2.05），P=0.26〕和急性腎功能衰竭〔OR=0.86，95% CI （0.41～1.80），P=0.69〕的發(fā)生率差異無統(tǒng)計(jì)學(xué)意義。
結(jié)論 　腔內(nèi)修復(fù)術(shù)可以作為治療急性Stanford B型主動(dòng)脈夾層的首選治療方法。

引用本文： 張克瑞,李新喜,王洋,羅軍,辛海,王可,田野,白超. 腔內(nèi)修復(fù)術(shù)與開放手術(shù)治療急性Stanford B型主動(dòng)脈夾層療效評(píng)價(jià). 中國普外基礎(chǔ)與臨床雜志, 2013, 20(10): 1092-1099. doi: 復(fù)制

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2. Orend KH， Liewald F， Kirchdorfer B， et al. Management of descending aortic dissection[J]. Ann Ital Chir， 1995， 66(6)： 821-824.
3. Nienaber CA， Eagle KA. Aortic dissection：new frontiers indiagnosis and management：PartⅡ：therapeutic management and follow-up[J]. Circulation， 2003， 108(6)：772-778.
4. Tefera G， Acher CW， Hoch JR， et al. Effectiveness of intensive medical therapy in type B aortic dissection：a single-center experience[J] . J Vasc Surg， 2007， 45(6)：1114-1118.
5. Umana JP， Miller DC， Mitchell RS. What is the best treatment for patients with acute type B aortic dissections—medical， surgical，or endovascular stent-grafting[J]. Ann Thorac Strg， 2002， 74(5)：S1840-S1843.
6. Hiratzka LF， Bakris GL， Beckman JA， et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease：executive summary. A report of the American College of Cardio-logy Foundation/American Heart Association Task Force on PracticeGuidelines， American Association for Thoracic Surgery， AmericanCollege of Radiology， American Stroke Association， Society of Cardiovascular Anesthesiologists， Society for Cardiovascular Angi-ography and Interventions， Society of Interventional Radiology， Society of Thoracic Surgeons， and Society for Vascular Medicine[J]. Catheter Cardiovasc Interv， 2010， 76(2)： E43-E86.
7. Parodi JC， PalmazJC， Baroned HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J]. Ann Vasc Surg， 1991， 5(6)： 491-499.
8. Dake MD， Kato N， Mitchell RS， et al. Endovascular stent-graft placement for the treatment of acute aortic dissection[J]. N Engl J Med， 1999， 340(20)：1585-1586.
9. Nienaber CA， Fattori R， Lund G， et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement[J]. N Engl J Med， 1999， 340(20) ：1539-1545.
10. Tsai TT， Fattori R， Trimarchi S， et al. Long-term survival in patients presenting with type B acute aortic dissection： insights from the International Registry of Acute Aortic Dissection[J]. Circulation， 2006， 114(21) ： 2226-2231.
11. Fattori R， Tsai TT， Myrmel T， et al. Complicated acute type B dissection：is surgery still the best option? a report from the International Registry of Acute Aortic Dissection[J]. JACC Cardiovasc Interv， 2008， 1(14)：395-402.
12. Garbade J， Jenniches M， Borger MA， et al. Outcome of patients suffering from acute type B aortic dissection：a retrospective single-center analysis of 135 consecutive patients[J]. Eur J CardiothoracSurg， 2010， 38(3) ：285-292.
13. Zeeshan A， Woo EY， Bavaria JE， et al. Thoracic endovascular aorticrepair for acute complicated type B aortic dissection： superiority relative to conventional open surgical and medical therapy[J]. J Thorac Cardiovasc Surg， 2010， 140(6) ： S109-S115.
14. Mastroroberto P， Onorati F， Zofrea S， et al. Outcome of open andendovascular repair in acute type B aortic dissection：a retros pec-tive and observational study[J]. J Cardiothorac Surg， 2010， 5：23.
15. Sachs T， Pomposelli F， Hagberg R， et al. Open and endovascularrepair of type B aortic dissection in the Nationwide Inpatient Sample[J]. J Vasc Surg， 2010， 52(4) ： 860-866.
16. Brunt ME， Egorova NN， Moskowitz AJ. Propensity score-matchedanalysis of open surgical and endovascular repair for type B aortic dissection[J]. Int J Vasc Med， 2011， 2011： 364046.
17. Murashita T， Ogino H， Matsuda H， et al. Clinical outcome of emergency surgery for complicated acute type B aortic dissection[J]. Circ J 2012， 76(3)： 650-654.
18. Tsai TT， Trimarchi S， Nienaber CA. Acute aortic dissection：perspectivies from the International Registry of Acute Aortic Dissection (IRAD)[J]. Eur J Vasc Endovasc Surg， 2009， 37(2)：149-159.
19. Schoder M， Czermy M， Cejna M， et al. Endovascular repair of acute type B aortic dissection：Long-term follow-up of true and false lumen diameter changes[J]. Ann Thorac Surg， 2007， 83(3) ：1059-1066.
20. Eggebrecht H， Nienaber CA， Neuhauser M， et al. Endovascular stent-graft placement in aortic dissection： a meta-analysis.[J]. Eur Heart J， 2006， 27(4) ：489-498.
21. Mukherjee D， Evangelista A， Nienaber CA， et al. Implications of periaortic hematoma in patients with acute aortic dissection (from the international registry of acute aortic dissection)[J]. Am J Cardiol， 2005， 96(12) ： 1734-1738.
22. Di Luozzo G， Geisbüsch S， Lin HM， et al. Open repair of desc-ending and thoracoabdominal aortic aneurysms and dissections in patients aged younger than 60 years： superior to endovascular repair?[J]. Ann Thorac Surg， 2013， 95(1)： 12-19.
23. Rerkasem K， Rothwell PM. Meta-analysis of small randomized controlled trials in surgery may be unreliable[J]. Br J Surg， 2010， 97(4) ：466-469.
  1. 1. Erbel R， Alfonso F， Boileau C， et al. Diagnosis and management of aortic dissection[J]. Eur Heart J， 2001， 22(18)：1642-1681.
  2. 2. Orend KH， Liewald F， Kirchdorfer B， et al. Management of descending aortic dissection[J]. Ann Ital Chir， 1995， 66(6)： 821-824.
  3. 3. Nienaber CA， Eagle KA. Aortic dissection：new frontiers indiagnosis and management：PartⅡ：therapeutic management and follow-up[J]. Circulation， 2003， 108(6)：772-778.
  4. 4. Tefera G， Acher CW， Hoch JR， et al. Effectiveness of intensive medical therapy in type B aortic dissection：a single-center experience[J] . J Vasc Surg， 2007， 45(6)：1114-1118.
  5. 5. Umana JP， Miller DC， Mitchell RS. What is the best treatment for patients with acute type B aortic dissections—medical， surgical，or endovascular stent-grafting[J]. Ann Thorac Strg， 2002， 74(5)：S1840-S1843.
  6. 6. Hiratzka LF， Bakris GL， Beckman JA， et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease：executive summary. A report of the American College of Cardio-logy Foundation/American Heart Association Task Force on PracticeGuidelines， American Association for Thoracic Surgery， AmericanCollege of Radiology， American Stroke Association， Society of Cardiovascular Anesthesiologists， Society for Cardiovascular Angi-ography and Interventions， Society of Interventional Radiology， Society of Thoracic Surgeons， and Society for Vascular Medicine[J]. Catheter Cardiovasc Interv， 2010， 76(2)： E43-E86.
  7. 7. Parodi JC， PalmazJC， Baroned HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J]. Ann Vasc Surg， 1991， 5(6)： 491-499.
  8. 8. Dake MD， Kato N， Mitchell RS， et al. Endovascular stent-graft placement for the treatment of acute aortic dissection[J]. N Engl J Med， 1999， 340(20)：1585-1586.
  9. 9. Nienaber CA， Fattori R， Lund G， et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement[J]. N Engl J Med， 1999， 340(20) ：1539-1545.
  10. 10. Tsai TT， Fattori R， Trimarchi S， et al. Long-term survival in patients presenting with type B acute aortic dissection： insights from the International Registry of Acute Aortic Dissection[J]. Circulation， 2006， 114(21) ： 2226-2231.
  11. 11. Fattori R， Tsai TT， Myrmel T， et al. Complicated acute type B dissection：is surgery still the best option? a report from the International Registry of Acute Aortic Dissection[J]. JACC Cardiovasc Interv， 2008， 1(14)：395-402.
  12. 12. Garbade J， Jenniches M， Borger MA， et al. Outcome of patients suffering from acute type B aortic dissection：a retrospective single-center analysis of 135 consecutive patients[J]. Eur J CardiothoracSurg， 2010， 38(3) ：285-292.
  13. 13. Zeeshan A， Woo EY， Bavaria JE， et al. Thoracic endovascular aorticrepair for acute complicated type B aortic dissection： superiority relative to conventional open surgical and medical therapy[J]. J Thorac Cardiovasc Surg， 2010， 140(6) ： S109-S115.
  14. 14. Mastroroberto P， Onorati F， Zofrea S， et al. Outcome of open andendovascular repair in acute type B aortic dissection：a retros pec-tive and observational study[J]. J Cardiothorac Surg， 2010， 5：23.
  15. 15. Sachs T， Pomposelli F， Hagberg R， et al. Open and endovascularrepair of type B aortic dissection in the Nationwide Inpatient Sample[J]. J Vasc Surg， 2010， 52(4) ： 860-866.
  16. 16. Brunt ME， Egorova NN， Moskowitz AJ. Propensity score-matchedanalysis of open surgical and endovascular repair for type B aortic dissection[J]. Int J Vasc Med， 2011， 2011： 364046.
  17. 17. Murashita T， Ogino H， Matsuda H， et al. Clinical outcome of emergency surgery for complicated acute type B aortic dissection[J]. Circ J 2012， 76(3)： 650-654.
  18. 18. Tsai TT， Trimarchi S， Nienaber CA. Acute aortic dissection：perspectivies from the International Registry of Acute Aortic Dissection (IRAD)[J]. Eur J Vasc Endovasc Surg， 2009， 37(2)：149-159.
  19. 19. Schoder M， Czermy M， Cejna M， et al. Endovascular repair of acute type B aortic dissection：Long-term follow-up of true and false lumen diameter changes[J]. Ann Thorac Surg， 2007， 83(3) ：1059-1066.
  20. 20. Eggebrecht H， Nienaber CA， Neuhauser M， et al. Endovascular stent-graft placement in aortic dissection： a meta-analysis.[J]. Eur Heart J， 2006， 27(4) ：489-498.
  21. 21. Mukherjee D， Evangelista A， Nienaber CA， et al. Implications of periaortic hematoma in patients with acute aortic dissection (from the international registry of acute aortic dissection)[J]. Am J Cardiol， 2005， 96(12) ： 1734-1738.
  22. 22. Di Luozzo G， Geisbüsch S， Lin HM， et al. Open repair of desc-ending and thoracoabdominal aortic aneurysms and dissections in patients aged younger than 60 years： superior to endovascular repair?[J]. Ann Thorac Surg， 2013， 95(1)： 12-19.
  23. 23. Rerkasem K， Rothwell PM. Meta-analysis of small randomized controlled trials in surgery may be unreliable[J]. Br J Surg， 2010， 97(4) ：466-469.