目的:功能性静脉端动脉侧(ETS)吻合术采用静脉端动脉侧(STS)吻合术与远端静脉结扎,STS吻合后可以达到与ETS相似的效果。该研究的目的是提供一项荟萃分析,以比较传统的和功能性的ETS吻合术在放射性头颅瘘透析中的临床结果。
方法:包括PubMed、EMBase,Cochrane图书馆,CNKI,万方数据库从成立之初到2020年2月6日检索。纳入了比较传统和功能性ETS吻合术在头颅瘘中的合格研究。使用ReviewManager版本5.3分析数据。
结果:7项研究纳入荟萃分析。确定了5项随机对照试验和2项队列研究,涉及841例患者。与传统的ETS吻合术相比,功能性ETS吻合时间较短(MD-9.54,95%CI-17.96至-1.12,P=0.03),手术成功率较高(OR3.80,95%CI1.76-8.22,P<0.01),并发症少(OR0.18,95%CI0.08-0.39,P<0.01),3个月后的通畅率较高(OR4.91,95%CI1.19-20.33,P=0.03),6个月后的通畅率较高(OR1.90,95CI1.09-3.31,P=0.02),12个月后通畅率较高(OR1.70,95%CI1.09-2.66,P=0.02)。两种动静脉(AVF)吻合方法后,AVF成熟时间(SMD-0.48,95%CI-1.30-0.34,P=0.25)和1个月后的通畅率没有差异(OR1.77,95%CI0.65-4.80,P=0.26)。
结论:功能性ETS吻合术具有操作简便的优点,手术成功率高,并发症少,3个月和长期的高通畅率,但在早期AVF成熟时间和1个月通畅率方面没有明显优势。
OBJECTIVE: Functional vein end to arterial side (ETS) anastomosis uses vein side to arterial side (STS) anastomosis with distal vein ligation, which can achieve similar effects as those of ETS after STS anastomosis. The purpose of the study was to provide a meta-analysis to compare the clinical outcomes between traditional and functional ETS anastomosis in radiocephalic fistula for dialysis access.
METHODS: Databases including PubMed, EMbase, the Cochrane Library, CNKI, Wanfang database were searched from the inception to February 6, 2020. Eligible studies comparing traditional and functional ETS anastomosis in radiocephalic fistula were included. Data were analyzed using Review Manager Version 5.3.
RESULTS: Seven studies were included in the meta-analysis. Five randomized controlled trials and two cohort studies involving 841 patients were identified. Compared with traditional ETS anastomosis, functional ETS anastomosis had shorter anastomosis time (MD - 9.54, 95% CI - 17.96 to - 1.12, P = 0.03), higher surgical success rate (OR 3.80, 95% CI 1.76-8.22, P < 0.01), fewer complications(OR 0.18, 95% CI 0.08-0.39, P < 0.01), higher patency rate after 3 months (OR 4.91, 95% CI 1.19-20.33, P = 0.03), higher patency rate after 6 months (OR 1.90, 95%CI 1.09-3.31, P = 0.02), higher patency rate after 12 months (OR 1.70, 95% CI 1.09-2.66, P = 0.02). There was no difference after the two arteriovenous (AVF) anastomosisl methods concerning AVF maturation time (SMD - 0.48, 95% CI - 1.30-0.34, P = 0.25) and patency rate after 1 month (OR 1.77, 95% CI 0.65-4.80, P = 0.26).
CONCLUSIONS: Functional ETS anastomosis had advantages of easy operation, high surgical success rate, few complications, high patency rate of 3 months and long-term, but did not have obvious advantage in the early stages concerning AVF maturation time and 1-month patency rate.