摘要
目的系统评价翻转式（eCEA）与标准式（cCEA）颈动脉内膜剥脱术治疗颈动脉狭窄的中远期疗效。方法计算机检索MEDLINE（1970年5月至2012年12月）、Ovid（1970-2012）、CBM（1970年5月至2012年12月）和CNKI（1970年5月至2012年12月）数据库。根据纳入和排除标准由两名研究者按Cochrane系统评价方法，独立选择文献、提取资料、评价各研究的方法学质量以及提取有效数据，采用STATA11．2软件进行荟萃分析。结果共纳入21篇相关文献（6篇为随机对照研究，15篇非随机研究），共统计15121例颈动脉狭窄患者，其中手术干预共16447例（eCEA组8617例，cCEA组7830例）。荟萃分析结果显示：eCEA组平均手术时间（WMD-85．00min，P〈0．01）以及颈动脉平均阻断时间（WMD-3．9min，P〈0．01）明显少于cCEA组；转流管的使用方面eCEA组少于cCEA组（OR=0．20，P〈0．01）。eCEA组的术后30d死亡率（OR=0．59，P=0．013）、早期脑卒中发生率（OR=0．63，P=0．044）、术后早期剩余部分再狭窄（OR=0．51，P=0．019）以及术后颈动脉闭塞的并发率（OR=0．44，P=0．001）明显低于cCEA组。虽然eCEA没有降低中远期的总死亡率（OR=0．81，P=0．143）和脑卒中的发生（OR=0．74，P=0．138），但是在中远期eCEA降低了再狭窄（OR=0．34，P〈0．01）和颈动脉闭塞（OR=0．30，P〈0．01）的发生率。亚组分析表明，eCEA组在早期脑卒中发生率、30d死亡率、脑卒中相关死亡率以及中期再狭窄方面优于标准式颈动脉内膜切除术补片闭合切口（CEA＋P）组。敏感性分析（RCT研究）结果表明，eCEA降低了中远期再狭窄（OR=0．43，95％CI：0．27，0．69，P〈0．01）以及颈动脉闭塞（OR=0．11，95％CI：0．02，0．62，P=0．012）的发生率。结论eCEA治疗颈动脉狭窄较cCEA具有手术时间短和阻断时间短的优点，同时降低了早期死亡率及脑卒中发生率，而且降低了中远期再狭窄发生率，但在中远期死亡率方面无显著优势。eCEA在中远期再狭窄发生率方面较CEA＋P组有明显优势，其他方面无明显优势。
Objective To evaluate the medium-long term effectiveness of eversion （eCEA） and conventional （cCEA） carotid endarterectomy on carotid artery stenosis. Methods We searched MEDLINE （1970-2012.12）, Ovid （1970 -2012）, CBM （1970 -2012.12） and CNKI （1970 -2012.12） database. Relevant journals and dissertation were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed through software STATA 11.2. Results A total of 21 studies were deemed eligible （8 617 eCEA and 7 830 cCEA procedures）, six of which were randomized and 14 non-randomized. Base on 15 121 patients underwent carotid artery stenosis including 16 447 cases, eCEA was association with a shorter mean operation time （ WMD - 85.00 rnin, P 〈 0. 001 ）, internal carotid artery clamp time （ WMD - 3.9 min, P 〈 0.01 ） and less shunt usage （ OR = 0. 20, P 〈 0. 01 ）. Furthermore, eCEA was associated with significant reduction in 30-day mortality （ OR = 0. 59, P =0. 013） , perioperative stroke （ OR = O. 63, P = 0. 044） , residual restenosis （ OR = O. 51, P =0. 019 ） and carotid artery occlusion （ OR = 0.44, P = 0. 001 ）. Although eCEA did not reduce medium-long term all-caused mortality （ OR = 0. 81, P = 0. 143） during follow-up time, eCEA presented with a significant reduction in late residual restenosis （OR =0. 34, P 〈0. 01 ） and carotid artery occlusion （OR =0. 30, P 〈 0. 01 ）. A sub-analysis was performed on studies directly comparing eCEA with patch CEA （ CEA ＋ P）, eCEA replicated the finding on perioperative stroke, 30-day mortality, and stroke-related death within short term and late residual restenosis. Concerning outcomes of RCT, eCEA presents with a significant reduction in the residual restenosis （ OR =0. 43, 95% CI： O. 27, 0. 69, P 〈0. 01 ） and carotid artery occlusion （ OR = 0. 11,95 % CI： 0. 02, 0. 62, P = O. 012） during following-up time. Conclusions Eversion CEA compared to conventional CEA may be associated with a short operation time and a short block time. eCEA appears to be associated with better 30-day mortality and stroke outcome than cCEA. Eversion CEA may be more effective for long-term prevention of restenosis, however, in the long term, it is not associated with a reduction in all-cause mortality.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第7期510-516,共7页
National Medical Journal of China
关键词
颈动脉狭窄
翻转式
荟萃分析
Eversion endarterectomy
Conventional endarterectomy
Meta-Analysis
