颅内破裂动脉瘤介入与显微开颅夹闭治疗效果的meta分析

Meta analysis of the clinical outcomes in treating ruptured intracranial aneurysm with microneurosurgical clipping or endovascular coiling

目的：评价血管内介入术与显微开颅夹闭术治疗颅内破裂动脉瘤的效果及并发症，以指导临床应用。方法：对纳入血管内介入术与显微开颅夹闭术治疗颅内破裂动脉瘤的对照试验资料，运用meta分析对纳入资料进行综合分析，计算其OR值（95％CI）。结果：两组完全闭塞率，术后3～12个月预后良好率、脑积水及脑血管痉挛发生率检验均P＜0.01，有统计学差异，合并分析结果OR值（95％CI）分别为0.32（0.22，0.48）、1.96（1.54，2.48）、1.92（1.22，3.02）、1.13（0.62，2.05）。结论：显微开颅夹闭组较血管内介入组动脉瘤完全闭塞率高；术后3～12个月患者良好率、脑积水发生率血管内介入组较夹闭组高；两组在脑血管痉挛发生率方面无统计学意义，考虑术后脑血管痉挛可能与疾病程度呈双向关系，根据患者临床分级进行分组研究可能更有临床意义。

Objective：To evaluate effectiveness and complications of microneurosurgical clipping and endovascular coiling in treatment of ruptured in-tracranial aneurysm for clinical evidence.Methods：The data were retrieved through randomized controlled trials（RCT） for treatment of ruptured intracrani-al aneurysm with either microneurosurgical clipping or endovascular coiling for meta analysis by calculating the confidence intervals of odds ratio （ OR,95%CI）.Results：The two groups were significant concerning the complete occlusion,better prognosis in 3 to 12 months after operation,incidences of hydro-cephalus and risks of cerebral vasospasm（all P〈0.01）,and the OR and 95% CI was 0.32（0.22,0.48）,1.96（1.54,2.48）,1.92（1.22,3.02） and 1.13（0.62,2.05）,respectively.Conclusion：Microneurosurgical clipping may lead to higher complete occlusion,better prognosis in 3 to 12 month after operation,and lower incidence of hydrocephalus for ruptured intracranial aneurysm , yet the risks of cerebral vasospasm remains similar with either ap-proach.Nevertheless,more clinical evidence shall be further gained in accordance with the clinical grading ,given that bidirectional relationship in cerebral vasospasm and the severity of ruptured intracranial aneurysm be existed .