中国颅外段椎动脉支架置入术的文献评价与现状  

Literature evaluation and current status of extracranial vertebral artery stenting in China

作　　者：冯瑶 李龙[1] 宋刚[1] 焦力群[1] Feng Yao;Li Long;Song Gang;Jiao Liqun(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 10053,China)

机构地区：[1]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2019年第6期316-320,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划(2016YFC1301700)

摘　　要：目的基于已发表的中文文献,探讨国内颅外段椎动脉支架置入术(VAS)的发展及现状。方法计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库,同时辅以手工检索,收集国内对VAS进行的文献报道,检索时间自数据库建库至2018年6月。由2名研究者分别独立按照纳入与排除标准行文献阅读及筛选,由第3名研究者进行资料核对。通过分析VAS在中国的地域分布、科室分布、麻醉方式、支架使用、手术疗效、临床转归、并发症、用药及再狭窄随访情况进行综合评价。结果(1)共检索相关文献1429篇,最后纳入178篇,总体质量较低,其中随机对照试验2篇(≤2分),前瞻性研究7篇(≤4分),回顾性病例对照研究和病例报告169篇。(2)VAS患者共8540例,由25个省、市、自治区及特别行政区参与完成,涉及神经疾病科(神经内科、神经外科、脑病科、神经科)、介入科、心内科、血管外科及未及科室名称者,其中神经疾病科完成VAS治疗占70.2%(5995/8540)。(3)报道麻醉方式的文献131篇(5950例),其中局部麻醉占78.7%(4680例),全身麻醉联合局部麻醉占18.3%(1090例),单纯全身麻醉占3.0%(180例)。(4)正确描述支架具体类型及数量的文献共26篇(965例),支架数量1015枚,居前三位者分别为Genesis支架227枚、Apollo支架179枚、Firebird支架118枚。(5)报道手术及其是否成功的文献166篇(7905例),报道临床症状的文献67篇(2418例),手术成功率99.7%(7882例),症状改善率93.8%(2269例)。(6)报道卒中或短暂性脑缺血的文献9篇(3853例),发生卒中或短暂性脑缺血发作215例,发生率为5.6%。(7)随访≥100例且随访时间>1年的文献共8篇(1693例),再狭窄发生率为25.4%(430例)。结论我国VAS技术应用已较普遍,但应由具备相应资质的医院完成VAS治疗,并制定相应的技术操作规范。应立足于高质量的研究设计,在我国VAS的导向方面,有待严谨的临床试验�Objective To summarize the development and current status of the technology of extracranial vertebral artery stenting(VAS) in China based on published Chinese literatures.Methods Using computer retrieval and manual retrieval method,China National Knowledge Infrastructure (CNKI),Wanfang Database,Weipu,and Sinomed were searched.Data were collected form identified domestic literatures on VAS published until June 2018.Two researchers independently read and screened the articles according to inclusion and exclusion criteria,and then the data were checked by a third researcher.A comprehensive evaluation of VAS in China was performed according to regional distribution,department distribution,anesthesia type,stent use,surgical effect,clinical outcome,complications,medication and restenosis. Results (1) A total of 1 429 relevant literatures were retrieved and 178 articles with low overall quality were recruited,including 2 randomized controlled trials (≤2 points),7 prospective studies (≤4 points) and 169 retrospective case-control studies and case reports.(2) A total of 8 540 patients with VAS were enrolled from 25 provinces,municipalities,autonomous regions and special administrative regions.Departments involved include Neurology or Neurology related,Intervention,Cardiology,Vascular Surgery and others not mentioned.Among them,70.2%(5 995/8 540) VAS were completed in Neurology or Neurology related Department.(3) 131 articles(5 950 cases)of anesthesia were reported,of which local anesthesia accounted for 78.7%(4 680 cases),general anesthesia combined with local anesthesia accounted for 18.3%(1 090 cases),and general anesthesia alone accounted for 3.0%(180 cases).(4) A total of 26 literatures(965 cases)had correctly described the types and quantities of scaffolds,a total number of 1 015 stents were reported.The top three stents used were Genesis stents (227),Apollo stents (178) and Firebird stents (118).(5) 166 articles(7 905 cases) of operation and its success rate were reported.A total of 67 literatures(2 418 cases) w

关 键 词：椎底动脉供血不足 支架置入术 文献评价 

分 类 号：R651.1[医药卫生—外科学] G353.1[医药卫生—临床医学]