中国颈动脉内膜切除术的文献评价与现状分析  

Literature evaluation and status quo analysis of carotid endarterectomy in China

作　　者：杨仁杰 李龙[1] 张潇 王亚冰[1] 马妍[1] 凌锋[1] 焦力群[1] Yang Renjie;Li Long;Zhang Xiao;Wang Yabing;Ma Yan;Ling Feng;Jiao Liqun(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2021年第3期158-167,共10页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划(2016YFC1301703);北京市科技计划课题(D161100003816002);中国工程院咨询研究项目(2018-XY-46)。

摘　　要：目的基于已发表的文献,探讨国内颈动脉内膜切除术(CEA)的现状与发展。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库,检索词采用主题词及其与自由词相结合的形式,包含“颈动脉内膜剥脱术”“颈动脉内膜剥离术”“颈动脉内膜切除术”的中文文献。检索时间为2012年1月至2019年12月。由2名研究者背靠背进行文献筛选和数据提取,存在异议时由第3名上级医师做出最后判定。文献筛选及数据提取:(1)文献报道的研究类型(随机对照试验、队列研究、病例对照研究和病例报告);(2)文献所在医院、科室、文献发表年份;(3)文献中报道的CEA例数、执行科室、病例资料跨越时间,患者的年龄、性别比例、发病症状、伴随疾病(高血压病、糖尿病、冠心病、高脂血症、外周动脉疾病)等;(4)治疗策略,包括CEA治疗前后的用药、手术适应证、麻醉方式(全身麻醉、颈丛阻滞局部麻醉)、显微镜使用情况、CEA术式(经典、补片、外翻式)、术中监测等;(5)患者围手术期情况,包括全因死亡、出血性卒中、缺血性卒中、心肌梗死、颅神经损伤、过度灌注综合征、术后切口血肿等;(6)随访结果,包括随访时间、再狭窄、症状性再狭窄等;(7)近期预后的影响因素,包括执行单位的手术容量、手术执行科室、转流技术策略、补片使用策略等。与国内已报道的CEA文献评价结果(文献检索时间为1983—2011年)进行对比。结果(1)共检索文献2540篇,依文献的纳入与排除标准,最终纳入文献484篇,共涉及29个省市自治区的173家医疗机构。排除文章、时间、患者数据的重叠后,共计CEA患者15630例。(2)CEA手术量的变化:2012—2019年,15630例CEA患者中,平均年手术量1953.75例,高于1983—2011年3504例CEA患者的平均年手术量(年均120.8例)。(3)大型中心CEA手术量的变化:2012—2019年国内文献报道显示,北京市�Objective To investigate the current situation and development of carotid endarterectomy(CEA)in China based on published literatures.Methods Subject headings and free words were searched in CNKI,Wanfang database,and Chinese biomedical literature database for Chinese literatures including“carotid endarterectomy”.The search period was from January 2012 to December 2019.Back-to-back literature screening and data extraction were performed by 2 investigators,and the final decision was made by a third supervisor physician in the presence of disagreement.Literature screening and data extraction:(1)Type of study reported in the literature(randomized controlled trial,cohort study,case-control study,and case report);(2)The hospital,department,and year of publication of the literature;(3)The number of CEA cases reported in the literature,executive departments,and case data spanning time,patients′age,gender ratio,onset symptoms,and concomitant diseases(hypertension,diabetes mellitus,and coronary heart disease,hyperlipidemia,peripheral arterial disease),etc.;(4)Treatment strategies,including medication before and after CEA treatment,indications for surgery,mode of anesthesia(general anesthesia,local anesthesia with cervical plexus block),use of microscopy,mode of CEA(classical,patch,eversion),intraoperative monitoring,etc.;(5)Perioperative conditions,including all-cause death,hemorrhagic stroke,ischemic stroke,myocardial infarction,cranial nerve injury,hyperperfusion syndrome,postoperative incisional hematoma,etc.;(6)Outcome of follow-up,including duration of follow-up,restenosis,symptomatic restenosis,etc.;(7)Influencing factors of recent prognosis,including operative volume of the executive unit,surgical executive department,strategy of flow technique,and strategy of patch use,etc.It was compared with the literature review results of CEA that have been reported in China(literature search period,1983-2011).Results(1)A total of 2540 articles were retrieved.According to the inclusion and exclusion criteria of the literat

关 键 词：颈动脉内膜切除术 颈动脉狭窄 文献评价 

分 类 号：R651.12[医药卫生—外科学]