支架植入与内膜剥脱治疗颈动脉狭窄的疗效与安全性评价.docVIP

支架植入与内膜剥脱治疗颈动脉狭窄的疗效与安全性评价★ 辛 海，白 超，王 洋，李新喜，罗 军，田 野，张克瑞(新疆医科大学第一附属医院血管甲状腺外科，新疆维吾尔自治区乌鲁木齐市 830054) 文章亮点： 文章的特色在于全面系统回顾并Meta分析评估所有目前公布的治疗颈动脉狭窄的随机对照试验，发现支架植入与颈动脉内膜剥脱治疗颈动脉狭窄的疗效和安全性各有千秋，相差不大。提示两种治疗模式是互补而不是对立的，应该综合分析每例患者的病情，对治疗方案进行优化选择。 关键词： 生物材料；生物材料循证医学；颈动脉狭窄；颈动脉支架植入；颈动脉内膜切除；随机对照试验；Meta分析；脑卒中 主题词： 生物相容性材料；颈动脉狭窄；支架；颈动脉内膜切除术 摘要 背景：大型随机试验已证明颈动脉内膜剥脱或支架植入治疗有症状和无症状颅外颈动脉狭窄是有效的。 目的：用Meta分析方法评价颈动脉支架植入和颈动脉内膜剥脱治疗颈动脉狭窄的疗效及安全性。 方法：计算机检索国内外数据库中关于颈动脉支架植入和颈动脉内膜剥脱治疗颈动脉狭窄的相关随机对照试验，按照纳入排除标准进行文献筛选和质量评价后，采用Cochrane协作网提供RevMan 5.0软件进行Meta分析。 结果与结论：共纳入14个研究7 693例患者，其中支架植入组3 835例，颈动脉内膜剥脱组3 858例。支架植入组术后30 d脑卒中事件发生率、术后30 d死亡与脑卒中事件发生率、术后1年心肌梗死事件发生率及术后30 d非致残性脑卒中事件发生率高于颈动脉内膜剥脱组(P ≤ 0.000 1)，术后30 d心肌梗死事件发生率低于颈动脉内膜剥脱组(P=0.001 0)。两组术后30 d死亡事件发生率及致残性脑卒中事件发生率差异无显著性意义。两种治疗模式是互补而不是对立的，应该综合分析每例患者的病情，对治疗方案进行优化选择。 Carotid artery stenting or carotid endarterectomy for treatment of carotid stenosis: Effectiveness and safety Xin Hai, Bai Chao, Wang Yang, Li Xin-xi, Luo Jun, Tian Ye, Zhang Ke-rui (Department of Thyroid Surgery, First Affiliated Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830054, Xinjiang Uygur Autonomous Region, China) Abstract BACKGROUND: Large randomized trials have demonstrated carotid endarterectomy or stenting for symptomatic and asymptomatic extracranial carotid stenosis is effective. OBJECTIVE: Using the meta analysis method, to evaluate efficacy and safety of carotid stenting and carotid endarterectomy for the treatment of carotid stenosis. METHODS: Computer-based retrieval of databases both at home and abroad was performed for randomized controlled trials related to carotid stenting and carotid endarterectomy for the treatment of carotid stenosis. According to exclusion criteria, literature screening was done followed by quality evaluation. Then, the enrolled literatures were analyzed by Cochrane collaboration with RevMan5.0 Meta analysis software. RESULTS AND CONCLUSION: There were 14 enrolled studies, including 7 693 patients among whom, 3 835 cases were