Effect of TEVAR Combined with Drugs and Drug Therapy Alone on the Efficacy and Safety of Stable Standford B Aortic Dissection.

Objective: Stanford type B aortic dissection is a condition in which the intima of the aorta tears, and TEVAR is an interventional treatment to manage this dissection through intimal repair. To evaluate the medium-term clinical efficacy of endovascular repair (TEVAR) for Aortic dissection and drug Conservative management for Stanford B Aortic dissection aneurysms and further explore whether the former is superior to drug Conservative management in the medium-term efficacy. Methods: The clinical data of 70 patients with stable Standford type B Aortic dissection admitted to our hospital from March 2016 to March 2020 were retrospectively analyzed. They were divided into the treatment group (n = 47) and the control group (n = 23). The control group patients were treated solely with medication, while the treatment group patients were treated with TEVAR on the basis of the control group patients. The treatment efficacy and safety of the two groups of patients were compared and analyzed. All patients will be followed up once a month for 12 months after discharge and every 2 months thereafter (for a total of 3 years). Results: The findings highlight the need to carefully weigh the benefits and harms in the treatment of Stanford type B aortic dissection, especially when considering TEVAR surgery. Future research should focus on reducing postoperative complications to optimize treatment strategies and improve overall patient outcomes.TEVAR surgery significantly reduces hospital mortality, but is also associated with significantly increased postoperative complications, emphasizing the complexity of treatment decisions. This finding provides critical information about weighing the risks and survival benefits of surgery, helping medical teams and patients make informed treatment choices. The hospital mortality rate of patients in the treatment group was 12.77%, while the hospital mortality rate of patients in the control group was 21.74%. The difference between the two groups was statistically significant (P < .05). The incidence of postoperative complications in the treatment group was 23.40%, while the control group did not experience any major complications. The difference between the two groups was statistically significant (P < .05). The mortality rate of patients in the treatment group within 30 days of discharge was 0%, while the mortality rate of patients in the control group within 30 days of discharge was 11.11%. The difference between the two groups was statistically significant (P < .05). The Kaplan Meier curve showed that the survival rates at 3 years of the control and treatment groups were 56.52% and 95.12%, respectively. The log-rank test showed a statistical difference between the two groups. Univariate and multivariate regression analysis showed that postoperative neurological complications (HR = 32.41; P = .00) and preoperative Aortic valve regurgitation (HR = 3.91; P = .00) were risk factors for medium-term death. Conclusion: The TEVAR combination drug is a safe and effective treatment for stable Stanford B Aortic dissection. It can reduce mortality. Compared with drug treatment, it has obvious advantages in medium-term treatment effects. Early rising for high-risk patients can make them have better long-term outcomes. Limitations of the study include its retrospective nature and the use of data from only a single medical center, which may limit the external generalizability of the results.

A systematic review and meta-analysis of video-assisted thoracoscopic surgery treating spontaneous pneumothorax.

BACKGROUND: With the adoption of high-tech thoracoscopic surgical instruments, video-assisted thoracoscopic surgery (VATS) has gradually replaced traditional thoracotomy and is used in the clinical treatment of spontaneous pneumothorax. METHODS: The composite logic retrieval and Boolean logic retrieval methods were adopted for this meta-analysis. Databases such as PubMed, Medline, Cochrane Library, CNKI, Wanfang, VIP, and Google Scholar were searched using the combination of search terms "Video-assisted thoracoscopic surgery", "spontaneous pneumothorax", and "thoracotomy". Literatures which used video-assisted thoracoscopic surgery for spontaneous pneumothorax as the experimental group were screened. The software RevMan 5.3 provided by the Cochrane system was employed for meta-analysis. RESULTS: A total of 12 studies were included. After the meta-analysis, heterogeneity testing of the operation time in 8 studies showed that Tau2 =29.99, Chi2 =16.99, degrees of freedom (df) =7, I2=59%>50%, and the operation time of participants in the experimental group was considerably inferior to that of control group. The mean difference (MD) was -31.02, 95% confidence interval (95% CI: -36.07 to -25.97), Z=12.03, P<0.0001. The heterogeneity test of the length of hospital stay in 9 studies showed that Tau2 =4.41, Chi2 =122.58, df =8, I2=59%>50%, P<0.01, and the length of hospital stay of participants in the experimental group was remarkably shorter than that of the control group. The MD was -7.29, 95% CI: (-8.76 to -5.82), Z=9.74, and P<0.01. The heterogeneity test of the bleeding volume in 6 studies showed that Tau2 =191.74, Chi2 =27.65, df =5, I2=82%>50%, P<0.01, and the bleeding volume of participants in the experimental group was remarkably lower in contrast to that of the control group. The MD was -65.48, 95% CI: (-77.84 to -53.13), Z=10.39, and P<0.01. The heterogeneity test of the chest tube removal time in 7 studies showed that Tau2 =0.29, Chi2 =28.27, df =6, I2=79%>50%, P<0.05, and the chest tube removal time of participants in the experimental group was substantially lower in contrast to that of the control group. The MD was -3.10, 95% CI: (-3.56 to -2.64), Z=13.30, P<0.01. DISCUSSION: This meta-analysis confirmed that VATS for spontaneous pneumothorax is better than other surgical methods.