【摘要】 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,P<0.01)。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(P<0.05)。(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。更多还原

【Abstract】 Objective To systematically review the short-term and long-term efficacy of eversion carotid endarterectomy( e CEA) and patch carotid endarterectomy( p CEA) for the treatment of carotid artery stenosis. Methods The published literature on e CEA and p CEA control studies in medline,Pub Med,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 e CEA group and 1 787 in the p CEA group). The results of meta-analysis showed that:( 1) the mean operative time in the p CEA group was shorter 22 ± 8 min than that in the p CEA group. The intraoperative utilization ratio of shunt tube,e CEA was significantly lower than p CEA,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% CI0. 23-0. 76,P = 0. 004) and the incidence of stroke after 30 d in e CEA were lower than those in p CEA( OR,0. 26,95% CI 0. 09-0. 78,P = 0. 02). There was significant difference.( 2) e CEA 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 p CEA,e CEA has the advantages of reducing the operation time and lowering the utilization rate of shunt tube. At the same time,e CEA can reduce the occurrence of stroke within 30 d and 30 d after procedure,and significantly reduce the incidence of restenosis.更多还原