目标:目前,关于Paget-Schroetter综合征(PSS)的最佳管理尚无共识。我们的目标是总结当前PSS管理的证据,并明确关注不同管理策略的临床结果。
方法:Cochrane,PubMed,并在Embase数据库中搜索了1990年1月至2021年12月之间发布的报告。
方法:遵循PRISMA2020指南进行了系统评价和荟萃分析。主要终点为末次随访时无症状患者的比例。次要结果是初始治疗的成功,血栓形成或持续性闭塞复发,最后随访时通畅。对非比较性和比较性报告进行主要终点的荟萃分析。使用GRADE方法评估证据质量。
结果:共纳入60份报告(2653例患者),总体质量适中。非比较分析中无症状患者的比例为:抗凝(AC),0.54;导管溶栓(CDT)+AC,0.71;AC+第一肋骨切除(FRR),0.80;和CDT+FRR,0.96.比较报告的汇总分析证实了CDT+FRR与AC相比的优越性(OR13.89,95%CI1.08-179.04;p<.040,I287%,证据的确定性非常低),AC+FRR(OR2.29,95%CI1.21-4.35;p=.010,I20%,证据的确定性非常低),和CDT+AC(OR8.44,95%CI1.12-59.53;p=0.030,I263%,证据的确定性非常低)。次要终点有利于CDT+FRR。
结论:非手术治疗单独使用AC的PSS导致46%的患者持续症状,而96%接受CDT+FFR治疗的患者在随访结束时无症状。CDT+FRR优于AC,CDT+AC,和AC+FRR通过荟萃分析得到证实。纳入报告总体质量中等,确定性水平“非常低”。
Currently, there is no consensus on the optimal management of Paget-Schroetter syndrome (PSS). The objective was to summarise the current evidence for management of PSS with explicit attention to the clinical outcomes of different management strategies.
The Cochrane, PubMed, and Embase databases were searched for reports published between January 1990 and December 2021.
A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. The primary endpoint was the proportion of symptom free patients at last follow up. Secondary outcomes were success of initial treatment, recurrence of thrombosis or persistent occlusion, and patency at last follow up. Meta-analyses of the primary endpoint were performed for non-comparative and comparative reports. The quality of evidence was assessed using the GRADE approach.
Sixty reports were included (2 653 patients), with overall moderate quality. The proportions of symptom free patients in non-comparative analysis were: anticoagulation (AC), 0.54; catheter directed thrombolysis (CDT) + AC, 0.71; AC + first rib resection (FRR), 0.80; and CDT + FRR, 0.96. Pooled analysis of comparative reports confirmed the superiority of CDT + FRR compared with AC (OR 13.89, 95% CI 1.08 - 179.04; p = .040, I2 87%, very low certainty of evidence), AC + FRR (OR 2.29, 95% CI 1.21 - 4.35; p = .010, I2 0%, very low certainty of evidence), and CDT + AC (OR 8.44, 95% CI 1.12 - 59.53; p = .030, I2 63%, very low certainty of evidence). Secondary endpoints were in favour of CDT + FRR.
Non-operative management of PSS with AC alone results in persistent symptoms in 46% of patients, while 96% of patients managed with CDT + FFR were symptom free at end of follow up. Superiority of CDT + FRR compared with AC, CDT + AC, and AC + FRR was confirmed by meta-analysis. The overall quality of included reports was moderate, and the level of certainty was very low.