外翻式与传统式颈动脉内膜切除术治疗颈动脉狭窄有效性和安全性的Meta分析

Meta-analysis of the Efficacy and Safety of Eversion and Conventional Carotid Endarterectomy in the Treatment of Carotid Stenosis

目的:通过Meta分析的手段评价外翻式与传统式颈动脉内膜切除术(CEA)治疗颈动脉狭窄有效性和安全性。方法:利用计算机检索PubMed、Embase、中国知网、万方等中英文数据库系统,获取了外翻式与传统式颈动脉内膜切除术治疗颈动脉狭窄的临床对照试验资料,并利用RevMan 5.4统计学程序,进行了Meta分析。结果:本研究共纳入11篇文章,外翻式颈动脉内膜切除术(eCEA)组(试验组)术中转流管应用数量占比低于传统式颈动脉内膜切除术(cCEA)组(对照组)[RR=0.17,95%CI(0.06,0.51),P=0.001];试验组的手术时间短于对照组[MD=-40.47,95%CI(-58.85,-22.09),P<0.0001];试验组的术后再狭窄率低于对照组[RR=0.43,95%CI(0.22,0.83),P=0.01]。结论:eCEA相对于cCEA在治疗颈动脉狭窄过程中可以减少术中转流管应用,缩短平均手术时间,降低术后再狭窄发生率。但是二者具体的治疗效果和安全性仍然需要大量高质量研究数据来长时间的验证。

Objective:To evaluate the efficacy and safety of eversion and traditional carotid endarterectomy(CEA)in the treatment of carotid stenosis by meta-analysis.Method:Clinical data of trials of eversion and conventional carotid endarterectomy in the treatment of carotid artery stenosis were obtained by computer searching PubMed,Embase,CKNI,Wanfang and other Chinese and English database systems,and a meta-analysis was conducted by RevMan 5.4 statistical program.Result:A total of 11 articles were included in this study,and the proportion of intraoperative diversion tubes in the eversion carotid endarterectomy(eCEA)group(experimental group)was lower than that in the conventional carotid endarterectomy(cCEA)group(control group)[RR=0.17,95%CI(0.06,0.51),P=0.001].The duration of surgery was shorter in the experimental group than that in the control group[MD=-40.47,95%CI(-58.85,-22.09),P<0.0001].The rate of postoperative restenosis in the experimental group was lower than that in the control group[RR=0.43,95%CI(0.22,0.83),P=0.01].Conclusion:Compared with the cCEA,eCEA can reduce the use of intraoperative diversion tubes in the treatment of carotid stenosis,shorten the average operation time,reduce the incidence of postoperative restenosis.However,the specific therapeutic efficacy and safety of both of them still need a lot of high-quality research data to verify for a long time.