比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤安全性和有效性的Meta分析

Safety and clinical effect of surgical clipping versus endovascular coiling in treatment of unruptured intracranial aneurysms:A meta-analysis

目的比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤的安全性和有效性。方法计算机检索1990至2018年颅内未破裂动脉瘤的所有临床对照研究。两名研究员分别纳入研究、提取数据、质量评价并应用Rev Man5.0软件进行数据处理。结果最终纳入21篇文献,病例数109114例。Meta分析结果提示:手术夹闭组动脉瘤闭塞率为88.2%,平均住院时间7.7天,均高于介入栓塞组的65.3%和4.1天,P<0.05。介入组患者的短期死亡率和致残率分别为0.61%和2.1%,均低于手术组的1.27%和4.7%,P<0.05。介入组患者的1年期死亡率和致残率(2.5%、2.5%)均与手术组(2.2%、1.8%)无明显差异,P>0.05。漏斗图未发现发表偏倚。敏感性分析结果一致。结论介入栓塞相比于手术夹闭可缩短患者的住院时间,降低患者的短期不良预后发生率。但是动脉瘤的闭塞率较低,1年期预后与手术夹闭无明显差异。据此推测手术夹闭患者的长期预后可能要好于介入栓塞,手术夹闭更适合于年轻患者。

Objective To compare the clinical effect and safety of surgical clipping versus endovascular coiling in the treatment of unruptured intracranial aneurysms. Methods A computerized search was performed in related databases to obtain controlled clinical trials on unruptured intracranial aneurysms. Two investigators independently selected the articles,extracted data,and performed quality assessment,and then Rev Man 5. 0 software was used for data processing. Results A total of 21 controlled clinical trials were included,with 109114 cases in total. The meta-analysis showed that compared with the endovascular coiling group,the surgical clipping group had a significantly higher occlusion rate of aneurysms( 88. 2% vs 65. 3%,PUnruptured intracranial aneurysm;Surgical clipping;Endovascular coiling;Meta-analysis < 0. 05) and a significantly longer hospital stay( 7. 7 days vs 4. 1 days,P < 0. 05). Compared with the surgical clipping group,the endovascular coiling group had significantly lower short-term mortality rate( 0. 61% vs 1. 27%,P <0. 05) and disability rate( 2. 1% vs 4. 7%,P < 0. 05). There were no significant differences between the endovascular coiling group and the surgical clipping group in 1-year mortality rate( 2. 5% vs 2. 2%,P > 0. 05) and 1-year disability rate( 2. 5% vs 1. 8%,P >0. 05). Funnel plots showed no publication bias,and sensitivity analysis obtained consistent results. Conclusions Compared with surgical clipping,endovascular coiling can shorten the length of hospital stay and reduce the incidence rate of short-term poor prognosis,but it has a lower occlusion rate of aneurysms and a similar 1-year prognosis as surgical clipping. Therefore,patients undergoing surgical clipping may have a better long-term prognosis than those undergoing endovascular coiling,and surgical clipping is more suitable for young patients.