对未破裂的内动脉瘤治疗的系统审查:剪切与卷轴对比
Zhe Shen1, Yachao Zhao, Xuanmin Gu
1The First Affiliated Hospital of Henan University of Science and Technology, Department of Neurosurgery, Luoyang, Henan, China.
Turkish neurosurgery
|April 23, 2024
概括
血管内提供较低的阻塞率,但与未破裂的大脑动脉瘤的手术剪切相比,降低了出血风险和短期死亡率. 长期结果似乎相似,尽管切割可能有利于年轻患者.
科学领域:
- 神经外科 神经外科
- 干预神经病学 干预神经病学
- 血管外科 血管外科
背景情况:
- 没有破裂的内动脉瘤具有很大的风险.
- 手术剪切和内血管卷圈是主要的治疗方式.
- 对临床结果的比较有效性数据对于治疗决策至关重要.
研究的目的:
- 为了比较内血管线圈与未破裂的内动脉瘤的外科切割.
- 评估临床结果的差异,包括死亡率,发病率和并发症率.
- 通过元分析综合控制临床研究的证据.
主要方法:
- 从1990年至2018年,对多个数据库 (MEDLINE,EMBASE,Cochrane,Wanfang,CNKI,VIP) 的综合文献搜索.
- 包括对照的临床研究,比较手术剪切和内血管卷曲.
- 使用RevMan 5软件对提取的数据进行元分析,以评估结果.
主要成果:
- 对23项涉及117,796名患者的研究进行了分析.
- 在剪切和卷轴之间,类似的缺血病率 (OR=1.36).
- 剪切显示出更高的闭塞率 (OR=5.31),出血风险 (OR=2.39),更长的住院时间 (OR=2.90),更高的短期死亡率 (OR=1.99) 和神经缺陷率 (OR=2.05).
- 两种方法的一年死亡率和赤字率都相似.
结论:
- 与手术剪切相比,内血管卷结与较低的出血风险,较短的住院时间以及较低的短期死亡率和发病率有关.
- 在这两种治疗方法之间,缺血风险,一年死亡率和发病率是可比的.
- 手术剪切可能会提供更好的长期结果,特别是在年轻的患者中,这需要进一步的研究.
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