外翻式与补片式颈动脉内膜切除术近远期疗效的Meta分析

目的系统评价外翻式颈动脉内膜切除术(e CEA)与补片式CEA(p CEA)治疗颈动脉狭窄的近远期疗效。方法计算机搜索Medline、Pub Med、Ovid、CNKI及CBM数据库已发表的e CEA与p CEA对照研究的文献,时间为1970年5月至2016年10月。根据纳入和排除标准,由2名研究者选择文献,提取资料及数据,采用Cochrane协作网专用软件Rev Man 5.2对近远期疗效指标数据进行Meta分析。结果共检索出1 137篇文献,纳入10篇文献(其中3篇随机对照研究)进行分析,共计3 213例颈动脉狭窄患者,手术干预3 299例次(其中e CEA组1 512例次,p CEA组共1 787例次)。Meta分析结果显示,(1)e CEA组平均手术时间较p CEA组缩短(22±8)min,术中转流管使用率e CEA明显低于p CEA,分别为12.6%(53/421)和50.2%(357/711,OR=0.11,95%CI:0.08~0.15,P0.01)。术后30 d内卒中发生率(OR=0.42,95%CI:0.23~0.76,P=0.004)和30 d后卒中发生率(OR=0.26,95%CI:0.09~0.78,P=0.02)e CEA均低于p CEA,差异均有统计学意义(P0.05)。(2)e CEA降低了术后30 d后再狭窄发生率(OR=0.57,95%CI:0.38~0.86,P=0.008)。结论 e CEA治疗颈动脉狭窄较p CEA具有手术时间短、转流管使用率低的优势;同时e CEA能降低术后30 d内、30 d后卒中的发生,并且明显降低再狭窄发生率。

Short-term and long-term efficacy of eversion and patch carotid endarterectomy:a meta-analysis

Objective To systematically review the short-term and long-term efficacy of eversion carotid endarterectomy (eCEA) and patch carotid endarterectomy (pCEA) for the treatment of carotid artery stenosis.Methods The published literature on eCEA and pCEA control studies in medline,PubMed,Ovid,CNKI and CBM (1970.5-2016.10) databases were retrieved by computers.Two reviewers selected literature and extracted data independently according to the inclusion and exclusion criteria.Cochrane Collaboration Network Special Software Rev Man 5.2 was used to analyze the meta-analysis of short-term and long-term outcome measures.Results A total of 1 137 articles were retrieved.Ten studies were included and analyzed (3 of them were randomized controlled trial).A total of 3 213 patients were enrolled,including surgical intervention 3 299 case/time (1 512 in the eCEA group and 1 787 in the pCEA group).The results of meta-analysis showed that:(1) the mean operative time in the pCEA group was shorter 22±8 min than that in the pCEA group.The intraoperative utilization ratio of shunt tube,eCEA was significantly lower than pCEA,they were 12.6 %(53/421) and 50.2% (357/711) respectively (OR,0.11,95%CI 0.08-0.15,P<0.01).The postoperative incidence of stroke within 30 d (OR,0.42,95%CI 0.23-0.76,P=0.004) and the incidence of stroke after 30 d in eCEA were lower than those in pCEA (OR,0.26,95%CI 0.09-0.78,P=0.02).There was significant difference.(2) eCEA reduced the incidence of restenosis at day 30 after procedure (OR,0.57,95%CI 0.38-0.86,P=0.008).Conclusion Compared with pCEA,eCEA has the advantages of reducing the operation time and lowering the utilization rate of shunt tube.At the same time,eCEA can reduce the occurrence of stroke within 30 d and 30 d after procedure,and significantly reduce the incidence of restenosis.