目的:血管环可引起气管和/或食管压迫。对于许多患者来说,症状/体征在诊断之前已经存在了很长一段时间。然而,在产前诊断的时代,一些单位提倡普遍的早期手术。必须知道手术的风险和疗效,才能为手术提供充分的建议。这项荟萃分析试图定义与手术矫正相关的发病率和死亡率。和持续的术后症状。
方法:PubMed,在Cochrane图书馆和CINAHL数据库中搜索了描述接受双主动脉弓或右主动脉弓(DAA或RAA)手术的患者结局的研究。进行了基于非比较和随机效应模型的荟萃分析,以计算合并死亡率,手术并发症,再干预,和持续的后续症状。
结果:纳入了19项符合条件的研究,其中18项研究描述了DAA手术的结局,15项研究描述了RAA手术的结局。对于DAA手术,总死亡率为0%[95%置信区间(CI)0.0-1.0],术后并发症发生率18%[95%CI:12.0-23.0],再干预患病率为3%[95%CI:1.0-5.0],末次随访时症状患病率为33%[95%CI:17.0-52.0].对于RAA手术,总合并死亡率为0%[95%CI:0.0-0.0],术后并发症的发生率为15%[95%CI:8.0-23.0],再干预率为2%[95%CI:0.0-4.0],末次随访时症状患病率为40%[95%CI:26.0-55.0].
结论:虽然手术矫正血管环是安全的,持续性症状的发生率很高,必须寻求进一步的策略来减轻这种负担.
OBJECTIVE: Vascular rings may cause tracheal and/or oesophageal compression. For many patients, symptoms/signs have been present for a long period before diagnosis. However, in the era of prenatal diagnosis, some units advocate universal early surgery. The risks and efficacy of surgery must be known to adequately counsel for the operation. This meta-analysis sought to define the morbidity and mortality associated with surgical correction, and persistent post-operative symptoms.
METHODS: PubMed, Cochrane Library and CINAHL databases were searched for studies that described the outcome of patients undergoing surgery for a double or right aortic arch (DAA or RAA). Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled rates of mortality, surgical complications, reintervention, and persistent follow-up symptoms.
RESULTS: Nineteen eligible studies were included comprising 18 studies describing outcomes for DAA surgery and 15 for RAA surgery. For DAA surgery, overall mortality rate was 0% [95% confidence interval (CI) 0.0-1.0], post-surgical complication rate 18% [95% CI: 12.0-23.0], prevalence of reintervention 3% [95% CI: 1.0-5.0] and prevalence of symptoms at last follow-up was 33% [95% CI: 17.0-52.0]. For RAA surgery, overall pooled mortality was 0% [95% CI: 0.0-0.0], prevalence of post-surgical complications was 15% [95% CI: 8.0-23.0], reintervention rate was 2% [95% CI: 0.0-4.0], prevalence of symptoms at last follow-up was 40% [95% CI: 26.0-55.0].
CONCLUSIONS: While surgery to correct a vascular ring is safe, the rate of persistent symptoms is high and further strategies must be sought to reduce this burden.