A Comprehensive Meta-Analysis for Bypass Surgery in Adult Moyamoya
A Comprehensive Meta-Analysis for Bypass Surgery in Adult Moyamoya
复制标题
成人烟雾病绕道手术的综合荟萃分析
DOI：
10.1016/j.wneu.2018.12.183
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发表时间：
2019
影响因子：
2
通讯作者：
Zhang Suming
中科院分区：
文献类型：
--
作者：
Yan Yawei;Li Yunjie;Huang Liangjiang;Zhang Suming
目的评估成人烟雾病的旁路手术的结果，并通过进行全面的荟萃分析相关study.MethodsA系统的文献检索和文章进行比较不同的手术方式与烟雾病的成人患者的不同治疗方法。计算比值比（OR），以评估不同的手术方法和保守治疗（CT）之间的中风复发，死亡率，围手术期并发症，血管造影血运重建。ResultsA共17项研究，2224例成人烟雾病患者纳入荟萃分析。与CT相比，手术血运重建显著降低了总人群（[OR] 0.404; 95%置信区间[CI] 0.279-0.585;P< 0.001）和卒中发作患者（OR 0.259; 95% CI 0.138-0.486;P< 0.001）未来卒中事件。然而，对于烟雾病和缺血患者，旁路和CT组之间未来卒中事件无显著差异（OR 0.470; 95%CI 0.140-1.579;P= 0.222）。与CT相比，旁路手术也没有降低死亡率（OR 0.372; 95% CI 0.120-1.154;P= 0.087）。对于不同的手术技术，直接旁路和间接旁路之间的未来卒中事件、死亡率和围手术期并发症没有差异，而直接旁路组的血管造影血运重建程度优于间接旁路组结论成人烟雾病患者，尤其是出血性烟雾病患者，转流治疗在预防脑卒中再发方面优于保守治疗，其效果上级。与间接旁路相比，直接旁路与更好的血运重建结果相关。
ObjectiveTo evaluate the outcomes of bypass surgery for adult moyamoya and compare different surgical modalities by performing a comprehensive meta-analysis of relevant studies.MethodsA systematic literature search was performed and articles regarding different treatments for adult patients with moyamoya were included. Odds ratios (ORs) were calculated to evaluate stroke recurrence, mortality, perioperative complications, and angiographic revascularization among different surgical methods and conservative treatment (CT).ResultsA total of 17 studies with 2224 adult patients with moyamoya were included in the meta-analysis. Compared with CT, surgical revascularization significantly decreased the future stroke events in the total population ([OR] 0.404; 95% confidence interval [CI] 0.279–0.585;P< 0.001) and in the hemorrhagic-onset patients as well (OR 0.259; 95% CI 0.138–0.486;P< 0.001). However, for those patients with moyamoya and ischemia, there was no significant difference for future stroke events between the bypass and CT groups (OR 0.470; 95% CI 0.140–1.579;P= 0.222). Bypass also showed no mortality reduction compared with CT (OR 0.372; 95% CI 0.120–1.154;P= 0.087). For different surgical techniques, no differences for future stroke events, mortality, and perioperative complications were found between direct bypass and indirect bypass, whereas the degree of angiographic revascularization was better in the direct bypass group than in the indirect group (OR 4.720; 95% CI 1.222–18.230;P= 0.024).ConclusionsThe bypass treatment was superior to conservative treatment in preventing recurrent stroke in adult patients with moyamoya, especially in those with a hemorrhagic onset. Direct bypass is associated with better revascularization results compared with indirect bypass.