介入栓塞和手术夹闭治疗破裂颅内动脉瘤效果比较的Meta分析

A Meta-analysis of effect comparison between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms

目的比较介入栓塞与手术夹闭治疗颅内动脉瘤的效果,为临床治疗方案的选择提供循证依据。方法检索Pubmed、Cochrane图书馆、Medline、Embase等数据库,收集有关介入栓塞和手术夹闭治疗颅内动脉瘤的随机对照研究。按照相关纳入排除标准由2名研究人员独立进行筛选并提取相关数据,以不良事件发生率、术后1年病死率、再次出血率、血管痉挛发生率和缺血性脑梗死发生率作为测量指标。采用RevMan5.3软件进行Meta分析。结果 16篇文献纳入分析,共7 373例患者,其中采用介入栓塞治疗的患者3 092例,采用手术夹闭治疗患者4 281例。介入栓塞组患者的不良事件发生率（OR=1.25,95%CI：1.12-1.40,P〈0.000 1）和再次出血率（OR=0.43,95%CI：0.28-0.66,P=0.000 1）均低于手术夹闭组;两组术后1年病死率（OR=1.13,95%CI：0.92-1.39,P=0.23）、血管痉挛发生率（OR=1.41,95%CI：0.99-2.02,P=0.06）和缺血性脑梗死发生率（OR=0.66,95%CI：0.42-1.05,P=0.08）无明显差异。结论根据目前临床研究证据表明,使用介入栓塞手术治疗破裂颅内动脉瘤相比手术夹闭可明显降低不良事件发生率,但增加再次出血率,而两种手术患者的术后1年病死率、血管痉挛发生率和缺血性脑梗死发生率则无明显差异。

Objective To compare the efficacies between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms to provide an evidence-based basis for selecting the clinical treatment scheme.Methods The related randomized controlled trail（RCT）literatures on the effects of interventional embolization and surgical clipping were retrieved from the databases of Pubmed,Cochrane,Medline and Embase.The screening was independently performed by two researchers according to the including and excluding criterion.The occurrence rate of adverse reactions,postoperative 1-year mortality rate,re-bleeding rate,occurrence rate of vasospasm and ischemic cerebral infarction served as the measurement indicators.The data were extracted and performed the meta analysis by the RevMan5.3software.Results Sixteen RCT literatures were included for conducting analysis,involving 7 373 patients,in which 3 092 cases adopted interventional embolization and 4 281 cases adopted surgical clipping.The occurrence rate of adverse events（OR=1.25,95%CI,1.12-1.40;P〈0.000 1）and re-bleeding rate（OR=0.43,95%CI,0.28-0.66;P=0.000 1）in the interventional embolization group were lower than those in the surgical clipping group;however,there were no statistical differences between the interventional embolization group and surgical clipping group in the postoperative 1-year mortality rate（OR=1.13,95%CI,0.92-1.39;P=0.23）,incidence rate of vasospasm（OR=1.41,95%CI,0.99-2.02;P=0.06）and incidence rate of ischemic cerebral infarction（OR=0.66,95%CI,0.42-1.05;P=0.08）.Conclusion The current clinical research evidences indicate that using the interventional embolization in treating ruptured intracranial aneurysms can obviously reduce the occurrence rate of adverse events than the surgical clipping,but increases the re-bleeding rate.The postoperative 1-year mortality rate,incidence rate of vasospasm and incidence rate of ischemic cerebral infarction have no obvious difference between these two kinds of operation.