沿皮纹横切口与经胸锁乳突肌前缘纵切口行颈动脉内膜斑块剥脱术安全性的meta分析

目的 系统评价沿皮纹横切口与经胸锁乳突肌前缘纵切口行颈动脉内膜斑块剥脱术（CEA）的安全性。方法 计算机检索PubMed、Medline、EMbase等英文数据库以及中国知网、中国生物医学文献数据库、万方数据库、维普数据库等中文数据库，收集公开发表的关于CEA中纵切口与横切口的随机对照研究或病例对照研究。检索年限为1979年7月1日至2019年2月1日。采用RevMan5.0软件进行meta分析。结果 共纳入7篇文献，其中中文1篇，英文6篇，共纳入CEA 1 287例，其中横切口组616例，纵切口组671例；随机对照试验3篇，病例对照研究4篇。meta分析结果显示两种切口术后切口血肿发生率、术后脑卒中、术后30 d病死率以及切口麻木发生率均无统计学差异（P>0.05）；横切口术后美观满意度明显优于纵切口（P<0.05），横切口术后喉返神经损伤率明显高于纵切口（P<0.05）。结论 沿皮纹横切口行CEA较经胸锁乳突肌前缘纵切口的喉返神经损伤概率较高，但术后切口美观度较好。

Meta-analysis of safety and cosmetic effects of transverse skin incision versus longitudinal incision for carotid endarterectomy

Objective To evaluate the safety and cosmetic effects of transverse skin incision and longitudinal incision for carotid endarterectomy. Methods The databases including CNKI, VIP, CBM, Wanfang, PubMed, Medline and EMbase were searched for the articles about the safety and cosmetic effects of transverse skin incision and longitudinal incision for carotid endarterectomy. The articles were screened according to the inclusion and exclusion criteria and the quality of the included articles was evaluated by Newcastle-Ottawa quality assessment scale and Jadad scale. Meta analysis 0f safety and cosmetic effects of the above-mentioned incisions for carotid endarterectomy was performed by RevMan5.0. Results A total of 7 studies, in which 1287 patients were involved including 616 patients were treated by the transverse skin incision and 671 by longitudinal incision, were recruited. There were insignificant differences in the incidences of incision hematoma, numbness in the incision skin and postoperative stroke, and mortality within 30 days after the operation between the two groups (P>0.05). The postoperative cosmetic effect of the transverse skin incision were significantly better than that of the longitudinal incision (P<0.05). The rate of recurrent laryngeal nerve injury was significantly higher in the transverse skin incision group than that in the longitudinal incision group (P<0.05). Conclusion Compared with the transverse skin incision, the longitudinal incision had significantly lower rate of the recurrent laryngeal nerve injury, but had significantly worse cosmetic outcomes in the patients with carotid arteries stenosis undergoing carotid endarterectomy.