颅内动脉瘤的显微外科夹闭术与Woven EndoBridge栓塞术比较：一项系统评价和荟萃分析。
完整摘要 · 中文译文
比较显微外科夹闭与Woven EndoBridge（WEB）栓塞治疗颅内动脉瘤（包括破裂和未破裂病例）在血管造影闭塞、并发症发生率、死亡率及不良事件（AEs）方面的差异。本系统评价和荟萃分析遵循PRISMA指南和Cochrane手册。检索PubMed、Scopus和Web of Science自建库至2026年1月29日，纳入评价显微外科夹闭与WEB栓塞比较的研究。无论动脉瘤破裂状态或形态如何，队列研究和临床试验均符合纳入条件。研究筛选和数据提取由两名评价者独立完成。使用纽卡斯尔-渥太华量表评估偏倚风险。采用随机效应模型计算合并风险比（RR）及95%置信区间（CI）。使用I²统计量评估异质性，并进行预先设定的亚组分析和敏感性分析。共纳入5项观察性队列研究，包含798例患者（402例夹闭，396例WEB）。来自高质量同期研究的最可信估计显示，夹闭的闭塞率更高（RR 1.30，95% CI 1.14至1.49，I² 0%）。较大的合并估计值（完全闭塞RR 1.71；两项研究宽颈分析中RR 2.04）受到使用外部WEB对照组的低质量研究以及夹闭闭塞率接近上限联合WEB分母较小的强烈影响，因此作为探索性结果呈现。充分或完全闭塞同样有利于夹闭（RR：1.61，95% CI：1.24-2.11）。 ；P = 0.0004）。发病率（RR：0.86，95% CI：0.33-2.25）或总死亡率（RR：0.69，95% CI：0.37-1.28）无显著差异。报告的不良事件发生率似乎大致相当，但由于各研究报告方式不一致，无法进行正式的对比分析，且两种技术的并发症特征有所不同。在宽颈动脉瘤中以及在可获得的短期随访范围内，显微外科夹闭始终与比WEB栓塞更高的血管造影闭塞率相关，后者是内部一致性更高的估计值，尽管将所有仅针对宽颈动脉瘤的研究合并后异质性有所增加。在发病率或死亡率方面未观察到统计学显著差异。由于WEB闭塞可能随时间推移而进展，且长期再治疗和复发数据有限，这些短期血管造影结果不应被解读为长期持久性更优的证据。由于所有纳入的研究均为观察性研究，这些比较易受选择偏倚影响，治疗方案的选择仍应根据动脉瘤特征、破裂状态和临床情况进行个体化决策。
完整摘要 · 英文原文
To compare microsurgical clipping and Woven EndoBridge (WEB) embolization for the treatment of intracranial aneurysms, including ruptured and unruptured cases, with respect to angiographic occlusion, morbidity, mortality, and adverse events (AEs). This systematic review and meta-analysis followed PRISMA guidelines and the Cochrane Handbook. PubMed, Scopus, and Web of Science were searched from inception to January 29, 2026, for comparative studies evaluating microsurgical clipping versus WEB embolization. Cohort studies and clinical trials were eligible regardless of aneurysm rupture status or morphology. Study selection and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I2 statistic, and predefined subgroup and sensitivity analyses were conducted. Five observational cohort studies comprising 798 patients (402 clipping, 396 WEB) were included. The most credible estimate, from the good-quality concurrent studies, showed higher occlusion with clipping (RR 1.30, 95% CI 1.14 to 1.49, I2 0%). Larger pooled estimates (RR 1.71 for complete occlusion; RR 2.04 in the two-study wide-neck analysis) were strongly influenced by fair-quality studies that used external WEB comparators and by near-ceiling clipping occlusion combined with small WEB denominators, and are presented as exploratory. Adequate or complete occlusion also favored clipping (RR: 1.61, 95% CI: 1.24-2.11; P = 0.0004). There were no significant differences in morbidity (RR: 0.86, 95% CI: 0.33-2.25) or overall mortality (RR: 0.69, 95% CI: 0.37-1.28). Reported adverse-event frequencies appeared broadly comparable, although inconsistent reporting across studies precluded formal comparative analysis, and the profile of complications differed between techniques. Across wide-neck aneurysms and within the available short-term follow-up, microsurgical clipping was consistently associated with higher angiographic occlusion than WEB embolization, which was the more internally consistent estimate, although heterogeneity increased when all wide-neck-only studies were combined. No statistically significant difference was observed in morbidity or mortality. Because WEB occlusion may progress over time and long-term retreatment and recurrence data are limited, these short-term angiographic findings should not be interpreted as evidence of superior long-term durability. Because all included studies were observational, these comparisons are susceptible to selection bias, and treatment selection should remain individualized according to aneurysm characteristics, rupture status, and clinical context.