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-  2018 

直接旁路手术和间接旁路手术治疗成人烟雾病比较的Meta分析 Direct Bypass Versus Indirect Bypass in Treating Adult Moyamoya:A Meta-Analysis

Keywords: 烟雾病,直接旁路手术,间接旁路手术,Meta分析

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Abstract:

目的:比较直接旁路手术和间接旁路手术两种手术方式治疗成人烟雾病(MMD)的安全性和有效性。方法:通过计算机检索Pubmed、Embase、Cochrane Central数据库,查找所有比较成人MMD的直接旁路手术和间接旁路手术的对照资料,检索的时间均为建库至2016年12月18日。同时手检纳入文献的参考文献。按预先制定的纳入标准和排除标准筛选出目标文献,由两人独立进行资料提取、质量评价后,使用RevMan 5.3软件进行Meta分析。结果:一共纳入9个研究,478例受试者。Meta分析的结果显示:(1)直接旁路手术在随访期卒中发生率较低,OR=0.59,95%CI(0.21,1.60),P=0.30,差异没有统计学意义。(2)直接旁路手术具有较好的血管再通率,OR=8.08,95%CI(3.52,18.56),P<0.000 01,差异有统计学意义。(3)在随访期内,直接旁路手术具有较高的血流动力学改善率,OR=2.10,95%CI(0.26,17.16),P=0.49,差异没有统计学意义。(4)直接旁路手术围手术期并发症发生率略高于间接旁路手术,OR=1.20,95%CI(0.47,3.06),P=0.70,差异没有统计学意义。结论:对于成人MMD,直接旁路手术和间接手术进行比较,直接旁路手术在血运重建上有明显优势;另外直接旁路手术在预防卒中发生上,似乎更为有效,但尚无统计学意义。由于受到所收集资料质量的限制,建议临床上审慎选择使用

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