摘要
目的分析比较开颅手术夹闭与血管栓塞介入术治疗脑动脉瘤破裂的效果。方法检索Pub Med、Cochrane图书馆、CNKI和万方数据库,收集2013-01—2018-04间发表的关于手术夹闭(夹闭组)与血管栓塞介入术(栓塞组)治疗脑动脉瘤疗效对比的文献,按纳入标准筛选文献、提取资料,然后利用Rev Man 5. 3软件进行Meta分析。结果 22篇文献纳入分析,共5 454例患者,其中夹闭组患者3 150例、栓塞组患者2 304例。Meta分析结果显示:2组术后患者的预后效果(OR=0. 73,95%CI:0. 52～1. 02,P=0. 07)、病死率(OR=0. 68,95%CI:0. 41～1. 13,P=0. 14)及致残率(OR=1. 41,95%CI:0. 90～2. 21,P=0. 13)无显著差异。栓塞组患者的术后并发症发生率低于夹闭组(OR=0. 48,95%CI:0. 39～0. 59,P <0. 000 01),但术后复发率高于夹闭组(OR=8. 33,95%CI:4. 73～14. 69,P <0. 000 01)。同时2组术后患者的血管痉挛发生率(OR=1. 21,95%CI:0. 73～1. 99,P=0. 46)、脑积水发生率(OR=0. 69,95%CI:0. 41～1. 17,P=0. 17)差异无统计学意义。而栓塞组患者术后再次出血率(OR=2. 7,95%CI:1. 56～4. 65,P=0. 000 4)及脑梗死发生率(OR=2. 39,95%CI:1. 78～3. 21,P <0. 000 01)均高于夹闭组;术后颅内感染发生率低于手术夹闭组(OR=0. 25,95%CI:0. 11～0. 58,P=0. 001)。结论手术夹闭与血管栓塞介入术治疗颅内动脉瘤各有利弊,临床医师应根据患者的具体情况合理选择治疗方案。
Objective To analyze and compare the efficacies between surgical clipping and endovascular coiling in the treatment of ruptured intracranial aneurysms. Methods The PubMed,Cochrane library,CNKI and Wanfang database were retrieved to collect the literature on comparing the curative effect of surgical clipping(clipping group)and endovascular coiling(coiling group)in the treatment of intracranial aneurysm during2013to2018.Selecting literature and extracting data were according to the including and excluding criterion,and then the data were extracted and performed the Meta analysis by the RevMan5.3software. Results Totally22literatures were included for conducting analysis,containing5454patients,in which3150patients adopted surgical clipping and2304patients adopted endovascular coiling.The results of Meta analysis showed that the prognosis(OR=0.73,95%CI:0.52-1.02,P=0.07),mortality(OR=0.68,95%CI:0.41-1.13,P=0.14)and disability rate(OR=1.41,95%CI:0.90-2.21,P=0.13)in the two groups had no significant difference.The incidence of postoperative complications in the coiling group was lower than the clipping group(OR=0.48,95%CI:0.39-0.59,P<0.00001),but the recurrence rate was higher than the clipping group(OR=8.33,95%CI:4.73-14.69,P<0.00001).At the same time,the incidence of vasospasm(OR=1.21,95%CI:0.73-1.99,P=0.46)and the incidence of hydrocephalus(OR=0.69,95%CI:0.41-1.17,P=0.17)in the two groups were not statistically significant,but the rebleeding rate(OR=2.7,95%CI:1.56-4.65,P=0.0004)and the incidence of cerebral infarction(OR=2.39,95%CI:1.78-3.21,P<0.00001)in the coiling group were higher than that of the clipping group.The incidence of intracranial infection in the coiling group was lower than that of the clipping group(OR=0.25,95%CI:0.11-0.58,P=0.001). Conclusion The surgical clipping and endovascular coiling for the treatment of intracranial aneurysms had advantages and disadvantages,the clinicians should choose the treatment options reasonably according to the specific conditions of the patients.
作者
凌兴飞
Ling Xingfei(Neurosurgery Department, Xinyang Central Hospital, Xinyang 464000, China)
出处
《河南外科学杂志》
2018年第6期1-4,共4页
Henan Journal of Surgery
关键词
颅内动脉瘤
手术夹闭
血管栓塞介入
破裂
Intracranial aneurysm
Surgical clipping
Endovascular coiling
Rupture
