Systematic review of randomized controlled trials of different types of patch materials during carotid endarterectomy.
Systematic review of randomized controlled trials of different types of patch materials during carotid endarterectomy.
复制标题
颈动脉内膜切除术中不同类型补片材料随机对照试验的系统评价
DOI：
10.1371/journal.pone.0055050
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Liu P
中科院分区：
文献类型：
--
作者：
Ren S;Li X;Wen J;Zhang W;Liu P
背景和目的颈动脉内膜切除术（CEA）联合膜片血管成形术比初次闭合效果更好；然而，CEA的最佳贴片材料仍存在不确定性。我们对随机对照试验（rct）进行了系统回顾，以评估在CEA期间使用静脉贴片与合成贴片材料、涤纶贴片与聚四氟乙烯（PTFE）贴片材料进行血管成形术的效果。方法通过Cochrane图书馆、Pubmed、Ovid、EMBASE和谷歌Scholar等多个电子健康数据库对2012年11月前发表的所有随机对照试验（rct）进行筛选，比较静脉贴片与人工贴片治疗CEA患者的结果。如果将自体静脉贴片与合成贴片材料的颈动脉贴片成形术进行比较，或将一种类型的合成贴片与另一种类型的贴片进行比较，则纳入随机对照试验。结果共纳入13项rct。10项试验，包括1946个cea，比较了静脉贴片和合成贴片材料。两项试验，涉及380名患者的400个cea，比较了涤纶贴片和PTFE贴片。PTFE贴片止血时间明显长于静脉贴片止血时间（P<0.0001），明显长于涤纶贴片止血时间（P<0.0001）。静脉补片与人工补片、涤纶补片与聚四氟乙烯补片的死亡率、卒中发生率、再狭窄、手术时间差异均无统计学意义（P < 0.05）。一项包含92例患者的95例cea的RCT比较了牛心包与涤纶贴片，结果显示术中牛心包缝合线出血与涤纶贴片相比有统计学意义的降低（P<0.001）。结论聚四氟乙烯贴片止血时间明显长于静脉贴片和涤纶贴片止血时间。在CEA中，静脉贴片与合成贴片材料、涤纶贴片与PTFE贴片材料的总围手术期和长期死亡率、卒中发生率、再狭窄和手术时间相似。需要更多的数据来阐明不同贴片材料之间的差异。
Background and Purpose Carotid endarterectomy (CEA) with patch angioplasty produces greater results than with primary closure; however, there remains uncertainty on the optimal patch material in CEA. A systematic review of randomized controlled trials (RCTs) was performed to evaluate the effect of angioplasty using venous patch versus synthetic patch material, and Dacron patch versus polytetrafluoroethelene (PTFE) patch material during CEA. Methods A multiple electronic health database screening was performed including the Cochrane library, Pubmed, Ovid, EMBASE and Google Scholar on all randomized controlled trials (RCTs) published before November 2012 that compared the outcomes of patients undergoing CEA with venous patch versus synthetic patch. RCTs were included if they compared carotid patch angioplasty with autologus venous patch versus synthetic patch material, or compared one type of synthetic patch with another. Results Thirteen RCTs were identified. Ten trials, involving 1946 CEAs, compared venous patch with synthetic patch materials. Two trials, involving 400 CEAs in 380 patients, compared Dacron patch with PTFE patch. The hemostasis time in CEA with PTFE patch was significantly longer than with venous patch (P<0.0001), and longer than with Dacron patch (P<0.0001). There was no significant difference of mortality rate, stroke rate, restenosis, and operative time in CEA with venous patch versus synthetic patch material, or in CEA with Dacron patch versus PTFE patch (all P>0.05). One RCT of 95 CEAs in 92 patients compared bovine pericardium with Dacron patch, and demonstrated a statistically significant decrease in intraoperative suture line bleeding with bovine pericardium compared with Dacron patch (P<0.001). Conclusions The hemostasis time in CEA with PTFE patch was longer than with venous patch or Dacron patch. The overall perioperative and long-term mortality rate, stroke rate, restenosis, and operative time were similar when using venous patch versus synthetic patch material or Dacron patch versus PTFE patch material during CEA. More data are required to clarify differences between different patch materials.
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