两种方式治疗颅内前循环动脉瘤的Meta分析

Meta analysis of two methods in treating intracranial anterior circulation aneurysms

目的比较血管内栓塞(EVT)与显微手术夹闭(NST)治疗颅内前循环动脉瘤的临床效果。方法检索2007年1月-2017年1月公开发表的EVT与NST治疗颅内前循环动脉瘤的随机对照试验(RCT)文献,根据标准筛选文献,提取有关临床效果指标进行Meta分析。结果按照筛选标准,共有3篇RCT共计489例颅内前循环动脉瘤患者纳入分析。EVT组与NST组患者基本特征均衡。EVT组发生血管痉挛率、动脉瘤术中破裂率、感染发生率均较NST组降低,差异有统计学意义(P<0.05);其他并发症间差异均无统计学意义(P>0.05);预后如GOS评分(4~5)和GOS评分(1~3)两组差异均无统计学意义(P>0.05)。结论 EVT血管痉挛、动脉瘤术中破裂及感染并发症发生率低,可安全治疗前循环动脉瘤,预后与NST无显著性差异。

Objective To compare the clinical effects between endovascular coiling therapy（EVT） and neurosurgical clipping（NST） of the intracranial anterior circulation aneurysms. Methods Literatures involved in randomized controlled trials of EVT and NST of the intracranial anterior circulation aneurysms published between Jan. 2007 to Nov. 2017 were selected according to stanadard and extracted parameters of clinical effects to process Meta. Results According to the screening criteria,a total of 489 cases with intracranial anterior circulation aneurysms in three RCT literatures were analyzed. Basic characteristics of the EVT group and the NST group were consistent. The rates of vasospasm and aneurysm intraoperative rupture and the incidence of infection in the EVT group were lower than those in the NST group,and the differences were statistically significant（P 0.05）;There was no statistical significance among other complications（P0.05）;After prognosis there was no statistical significance between GOS score（4~5） and GOS score（1~3）（P0.05）. Conclusion EVT vasospasm,aneurysm intraoperative rupture and infection rate are low with safty treatment of intracranial anterior circulation aneurysms, there was no statistical significance compared to NST after prognosis.