直接旁路手术和间接旁路手术治疗成人烟雾病比较的Meta分析

Direct Bypass Versus Indirect Bypass in Treating Adult Moyamoya:A Meta-Analysis

目的：比较直接旁路手术和间接旁路手术两种手术方式治疗成人烟雾病（MMD）的安全性和有效性。方法：通过计算机检索Pubmed、Embase、Cochrane Central数据库,查找所有比较成人MMD的直接旁路手术和间接旁路手术的对照资料,检索的时间均为建库至2016年12月18日。同时手检纳入文献的参考文献。按预先制定的纳入标准和排除标准筛选出目标文献,由两人独立进行资料提取、质量评价后,使用RevMan 5.3软件进行Meta分析。结果：一共纳入9个研究,478例受试者。Meta分析的结果显示：（1）直接旁路手术在随访期卒中发生率较低,OR=0.59,95%CI（0.21,1.60）,P=0.30,差异没有统计学意义。（2）直接旁路手术具有较好的血管再通率,OR=8.08,95%CI（3.52,18.56）,P〈0.000 01,差异有统计学意义。（3）在随访期内,直接旁路手术具有较高的血流动力学改善率,OR=2.10,95%CI（0.26,17.16）,P=0.49,差异没有统计学意义。（4）直接旁路手术围手术期并发症发生率略高于间接旁路手术,OR=1.20,95%CI（0.47,3.06）,P=0.70,差异没有统计学意义。结论：对于成人MMD,直接旁路手术和间接手术进行比较,直接旁路手术在血运重建上有明显优势;另外直接旁路手术在预防卒中发生上,似乎更为有效,但尚无统计学意义。由于受到所收集资料质量的限制,建议临床上审慎选择使用。

Objective： To ypass surgery for objectively evaluate the treating adult moyamo efficacy ya diseas base and Cochrane Central were searched from esta puter in order to look for articles comparing direct and safety of e. Methods ： blishment to bypass with direct bypass surgery and indirect Databases such as Pubmed, Em- December 18, 2016 through corn- indirect bypass for treating adult MMD. The references of these articles were also searched by hand. After screening all the articles according to including and excluding criteria, two reviewers independently conducted the data extraction and assessment of the targeting articles. Meta-analyses were performed by using the RevMan 5.3 software. Results. Nine studies involving 478 patients were included. The results of meta-analyses showed that. （2）By the end of follow-up period, we saw a lower stroke incidence in the direct bypass group than in the indirect bypass group （odds ratio, 0.59- 95% confidence in- terval,0.21-1.60% P=0.30） without statistic differences.（1）By the end of follow-up period, the pooled OR of good revascularization in adult moyamoya angiopathy patients of the direct bypass group compared with the indirect bypass group was 8.08 （95% confidence interval, 3.52-18.56% P=0. 000 01）, with significant statistic differences.（3）In our meta-analysis, to compare the he- modynamic improvement after direct bypass and indirect bypass, it indicated that the direct by- pass was better with a OR of 2. 10, 95% confidence interval 0. 26-17.16, P=0.49, though no statistic difference was suggested. @During perioperative period, there was a slightly higher perioperative complication rate in the direct bypass group with an OR of 1.20, 95 ~ confidence in- terval 0.47-3.06, P=0.70, however, no statistic difference was suggested. Conclusion; In trea- ting adult MMD, direct bypass surgery can perform much better in angiographic revascularization than indirect bypass surgery does during follow-ups. In addition, direct bypass seems to act bet- ter in preventing future strokes than indirect bypass does, although no statistic difference was suggested. Due to the poor quality of original studies, a prudent choice is suggested.