颅内动脉瘤(IA)可引起颅内压升高,头痛,如果不及时治疗,恶心和呕吐的发展,未能及时诊断和治疗可能导致残疾或死亡。然而,IA患者开颅手术和血管内栓塞的疗效和预后价值仍是一个有争议的话题.这项荟萃分析系统评估了血管内盘绕术与颅内动脉瘤钳夹术对IA患者术后近期预后和预后的影响。PubMed,EMBASE,并搜索Cochrane图书馆数据库以检索相关参考文献。根据预先定义的纳入和排除标准筛选文献,并对数据进行提取和质量评估。共10项研究,包括2654例,包括在分析中。其中,1313例患者行开颅夹闭手术(夹组),1,341例接受了血管内线圈(线圈组)。使用纽卡斯尔-渥太华量表(NOS)评估的8篇文章的研究质量≥6。采用RevMan5.3和Stata17软件进行Meta分析。Meta分析结果显示,完全闭塞率[OR=1.76,95%CI(0.78,3.96),P=0.17]当比较夹子和线圈组时。与剪辑组相比,线圈组具有更好的临床短期结果[OR=1.55,95%CI(1.05,2.27),P=0.03],但术后残留或复发率增加[OR=0.40,95%CI(0.17,0.91),P=0.03]。此外,在并发症方面没有显着差异,包括术后再出血率[OR=1.60,95%CI(0.97,2.63),P=0.07],缺血性卒中[OR=1.12,95%CI(0.45,2.79),P=0.81],和脑血管痉挛[OR=0.90,95%CI(0.13,6.03),P=0.91]。随后,我们对每个指标进行了实验序列分析,结果与荟萃分析结果一致.根据最近的临床预后,建立了漏斗图,两侧都表现出明显的不对称,表明了一些出版偏见。然而,Begg检验(P=0.734)和Egger检验(P=0.633)的结果表明没有显著的发表偏倚。总的来说,血管内卷绕和显微外科手术夹闭似乎在实现血管闭塞方面同样有效。血管内卷绕可能更有效地改善患者的短期临床结果。然而,这种方法可能会增加术后残留问题或复发率.
Intracranial aneurysms (IA) can induce increased intracranial pressure, headache, and the development of nausea and vomiting if not treated in time, and failure to receive timely diagnosis and treatment can lead to disability or death. However, the efficacy and prognostic value of craniotomy and endovascular embolization in patients with IA remains a controversial topic. This meta-analysis systematically evaluated the efficacy of endovascular coiling versus cranial aneurysm clamping on the immediate postoperative outcome and prognosis of patients with IA. PubMed, EMBASE, and the Cochrane Library databases were searched for retrieval of relevant references. Literature was screened according to pre-defined inclusion and exclusion criteria, and data were extracted and assessed for quality. A total of 10 studies, including 2,654 cases, were included in the analysis. Among them, 1,313 cases underwent craniotomy clipping surgery (clip group), and 1,341 cases underwent endovascular coiling (coil group). The quality of the studies in 8 articles evaluated using the Newcastle-Ottawa Scale (NOS) was ≥6. Meta-analysis was conducted using Rev Man 5.3 and Stata 17 software. The results of meta-analysis showed that no significant difference in complete occlusion rate [OR=1.76, 95% CI (0.78, 3.96), P=0.17] when comparing the clip and coil group. Compared to the clip group, the coil group had a better clinical short-term outcome [OR=1.55, 95% CI (1.05, 2.27), P=0.03], but an increased rate of postoperative residual or recurrence [OR=0.40, 95% CI (0.17, 0.91), P=0.03]. In addition, there were no significance differences identified in terms of complications, including the rates of postoperative rebleeding [OR=1.60, 95% CI (0.97, 2.63), P=0.07], ischemic stroke [OR=1.12, 95% CI (0.45, 2.79), P=0.81], and cerebral vasospasm [OR=0.90, 95% CI (0.13, 6.03), P=0.91]. Subsequently, we conducted experimental sequence analysis for each indicator, and the results were consistent with the results of meta-analysis. According to the recent clinical prognosis, a funnel plot was constructed, showing significant asymmetry on both sides, indicating some publication bias. However, the results of Begg\'s test with P=0.734 and Egger\'s test with P=0.633 suggest no significant publication bias. In general, endovascular coiling and microsurgical clipping appear to be equally effective in achieving vascular occlusion. Endovascular coiling may be more effective in improving the short-term clinical outcomes for patients. However, this approach may increase the rate of postoperative residual issue or recurrence.