Abstract：
Minimally invasive surgery is a useful alternative to open repair for patients with nonruptured abdominal aortic aneurysms (AAA). We aim to compare the clinical outcomes for three different minimally invasive techniques: hand-assisted laparoscopic surgery (HALS), total laparoscopic surgery (TLS), and endovascular aneurysm repair (EVAR). The electronic databases MEDLINE, Embase, Web of Science, Google Scholar, and the Cochrane Library were searched between January and March 2023. Cohort studies and randomized controlled trials (RCTs) comparing two minimally invasive techniques were eligible for inclusion. Primary outcomes were mortality (in-hospital, 30-day, or 1-year) and reintervention rates (30-day or 1-year). Length of surgery, blood loss, transfusion volume, conversion to open surgery, major complication rates, length of hospital stay, and length of intensive care unit (ICU) stay were also evaluated. Eight cohort studies and one RCT were included comparing patients undergoing HALS (n = 500), TLS (n = 263), and EVAR (n = 438) for elective AAA repair. The TLS group had the highest rate of 30-day postoperative reinterventions (p = 0.00056), the longest surgical duration (p = 0.0311), and the highest rate of conversion to open surgery (p < 0.001). TLS was also associated with the most blood loss during surgery, the highest blood transfusion volumes, and the longest length of ICU stay, although these results did not reach statistical significance. Subgroup analysis revealed superior contemporary EVAR outcomes compared to TLS. Laparoscopic surgery (LAS) and EVAR have comparable mortality rates. However, LAS, particularly TLS, is significantly less efficacious than EVAR in terms of intraoperative conversions to open surgery and 30-day reintervention rates. Further controlled trials with larger sample sizes are needed to confirm the evidence.
摘要：
对于未破裂的腹主动脉瘤（AAA）患者，微创手术是开放修复的有用替代方法。我们的目的是比较三种不同的微创技术的临床结果：手助腹腔镜手术（HALS），全腹腔镜手术（TLS），血管内动脉瘤修复术（EVAR）。MEDLINE电子数据库，Embase,WebofScience,谷歌学者，和Cochrane图书馆在2023年1月至3月之间进行了搜索。比较两种微创技术的队列研究和随机对照试验（RCT）符合纳入条件。主要结果是死亡率(住院，30天,或1年)和再干预率(30天或1年)。手术长度,失血,输血量,转换为开放手术，主要并发症发生率,住院时间,还评估了重症监护病房（ICU）的住院时间。纳入了8项队列研究和1项RCT，比较接受HALS的患者（n=500），TLS（n=263），和EVAR(n=438)用于选择性AAA修复。TLS组术后30天再干预率最高（p=0.00056），手术时间最长（p=0.0311），开腹手术的转化率最高(p<0.001)。TLS也与手术过程中失血最多相关，输血量最高,ICU住院时间最长,尽管这些结果没有达到统计学意义。亚组分析显示，与TLS相比，当代EVAR结果优越。腹腔镜手术（LAS）和EVAR的死亡率相当。然而,LAS,特别是TLS,在术中转换为开放手术和30天再干预率方面，效果明显低于EVAR。需要更大样本量的进一步对照试验来确认证据。
