国内采用载瘤动脉闭塞术与重建术治疗颅内夹层动脉瘤的Meta分析

Deconstruction and reconstruction treatments of intracranial dissecting aneurysms：A Meta-analysis of domestic data

目的 统计国内采用载瘤动脉闭塞术和重建术（包括单、多支架辅助弹簧圈栓塞及支架重叠）治疗颅内夹层动脉瘤的疗效,以评价两种术式治疗颅内夹层动脉瘤的安全性和有效性.方法 检索2008年1月至2017年12月Pubmed数据库、万方医学网关于国内采用血管内治疗颅内夹层动脉瘤的文献,并提取文献数据.使用RevMan 5.3软件进行统计学分析,对比载瘤动脉闭塞术与重建术在治疗颅内夹层动脉瘤中的有效性与安全性.计数的并发症包括夹层动脉瘤复发、术后相关的死亡与其他围手术期并发症.结果 纳入文献18篇,共1 102例（包括536例缺血患者和566例出血患者）颅内夹层动脉瘤患者.末次随访显示,采用载瘤动脉闭塞术治疗的269例（闭塞组）患者中,复发8例（2.97％）,死亡5例（1.86％）,发生围术期并发症15例（5.58％）.采用载瘤动脉重建术治疗的833例（重建组）患者中,复发98例（11.76％）,死亡10例（1.20％）,发生围手术期并发症16例（1.92％）.采用固定效应模型比较两组的结果显示,闭塞组的复发率低于重建组（OR =0.36,95％ CI：0.20～0.64,I2=12％,P=0.0005）;闭塞组的致死、致残率高于重建组（OR=2.35,95％ CI：1.27～ 4.23,I2=4％,P=0.0006）;两组的全部并发症发生率比较,重建组（14.89％,124/833）总体高于闭塞组（10.40％,28/269）,但差异无统计学意义.（OR =0.69,95％ CI：0.45～1.05,I2=37％,P=0.0800）.结论 在颅内夹层动脉瘤的血管内治疗中,载瘤动脉闭塞术的有效性与安全性优于重建术.但随着新材料的不断出现,重建术治疗的有效性将有望得到提升.

Objective To analyze the effect and safety of treating intracranial dissecting aneurysm （IDA） by deconstruction and reconstruction in China.Methods We searched the literatures about interventional treatment of IDA in Pubmed and Wanfang medical ranging from January 2008 to December 2017 and withdrew the data from abstracts in literature.Comparing the effectiveness and safety of deconstruction and reconstruction in treating IDA by using RevMan 5.3,this study counted events consisting of postoperative recurrence,death related to IDA,and other perioperative complications.Results A total of 18 articles reported 1 102 cases of IDA including 269 cases with deconstruction and 833 cases with reconstruction.In the deconstruction group,there were 8 （2.97％） cases of recurrence,5 （1.86％） deaths,15 （5.58％） cases of other perioperative complications.In the reconstruction group,there were 98 （11.76％） cases of recurrence,10 （1.20％） cases of death and 16 （1.92％） cases of other perioperative complications,which were summed up to a total of 124 （14.89％） cases.In the fixed effect model,comparison between the 2 groups in dissection recurrence （OR =0.36,95％ CI：0.20-0.64,I2 =12％,P =0.0005） indicated that the risk of recurrence in deconstruction group was lower than that in the reconstruction group.In addition,comparison of the complications except recurrence （OR =2.35,95％ CI：1.27-4.23,I2 =4％,P =0.0006） showed that the risks of mortality,disability and other complications were lower in deconstruction group.Comparing all complications （OR =0.69,95％ CI：0.45-1.05,I2 =37％,P =0.0800） suggested that deconstruction was better than reconstruction in treating IDA.Conclusion The effect and safety of deconstruction might be better than those of reconstruction in treating IDA.With the development of materials,the effect of reconstruction would be expected to improve.