床突旁动脉瘤外科治疗的荟萃分析  

A Meta-analysis of surgical treatment for paraclinoid aneurysms

作　　者：俞正勇 齐文涛[3] 段晓春 黄莹 YU Zhengyong;QI Wentao;DUAN Xiaochun;HUANG Ying(Yangzhou University,Yangzhou,Jiangsu,225001;Department of Brain Surgery,Funing County People′s Hospital of Jiangsu Province,Yancheng,Jiangsu,224400;Department of Neurosurgery,the Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu,225001;Department of Neurosurgery,Shenzhen Samii Medical Center of Guangdong Province,Shenzhen,Guangdong,518118;the First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha,Hunan,410007)

机构地区：[1]扬州大学,江苏扬州225001 [2]江苏省阜宁县人民医院脑外科,江苏盐城224400 [3]扬州大学附属医院神经外科,江苏扬州225001 [4]广东省深圳市萨米医疗中心神经外科,广东深圳518118 [5]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《实用临床医药杂志》2023年第13期6-15,共10页Journal of Clinical Medicine in Practice

基　　金：湖南省自然科学基金项目(2022JJ30454)。

摘　　要：目的采用系统回顾及荟萃分析的方法对已发表的床突旁动脉瘤手术夹闭和血管内栓塞治疗的系列文献进行分析。方法采用计算机检索PubMed和Web of Science电子数据库,获取1980年1月-2022年12月床突旁动脉瘤手术夹闭和血管内栓塞治疗的文献。分析文献中完全闭塞率、症状改善率和相关并发症发生率的差异。结果本研究系统回顾了37篇共2698例患者的临床资料,其中1164例患者接受了血管内栓塞治疗(血管内栓塞组),1534例患者进行了手术夹闭(手术夹闭组)。血管内栓塞组的完全闭塞率低于手术夹闭组,差异有统计学意义(OR=0.53,95%CI:0.37~0.77,P=0.001,I 2=0%)。手术夹闭组的症状改善率优于血管内栓塞组,差异有统计学意义(OR=0.26,95%CI:0.14~0.50,P<0.001,I 2=5.9%)。2组并发症发生率差异无统计学意义(OR=0.25,95%CI:0.03~2.20,P=0.21,I 2=7.43%)。结论与血管内栓塞相比,手术夹闭治疗可增高完全闭塞率,改善症状似乎更有利,但术中及术后并发症发生率也相应增高。Objective To analyze a series of published literatures on surgical clipping and endovascular embolization treatment for paraclinoid aneurysms by systematic review and the Meta-analysis.Methods The computer was used to search electronic databases such as PubMed and Web of Science to obtain literatures on surgical clipping and endovascular treatment for paraclinoid aneurysms from January 1980 to December 2022.The differences in the rate of complete occlusion,the improvement rate of symptoms,and the incidence rate of related complications in literatures were analyzed.Results This study systematically reviewed the clinical materials of 2698 patients from 37 studies,of which 1,164 patients(endovascular embolization group)received endovascular embolization treatment,and 1,534 patients(surgical clipping group)underwent surgical clipping.The complete occlusion rate of endovascular embolization group was significantly lower than that of surgical clipping group(OR=0.53;95%CI,0.37 to 0.77;P=0.001;I 2=0%).The improvement rate of symptoms in the surgical clipping group was significantly better than that in the endovascular embolization group(OR=0.26;95%CI,0.14 to 0.50;P<0.001;I 2=5.9%).There was no significant difference in the incidence of complications between the two groups(OR=0.25;95%CI,0.03 to 2.20;P=0.21;I 2=7.43%).Conclusion Compared with endovascular embolization,surgical clipping treatment can increase the complete occlusion rate,which seems more beneficial for improving symptoms,but the incidence of intraoperative and postoperative complications increases.

关 键 词：床突旁动脉瘤 血管内栓塞治疗 手术夹闭 系统回顾 荟萃分析 

分 类 号：R543.1[医药卫生—心血管疾病] R605[医药卫生—内科学]