烟雾病与非烟雾病病理直接颅外-颅内搭桥术后结局比较：一项系统综述和荟萃分析。
完整摘要 · 中文译文
颅外-颅内（EC-IC）血管搭桥术是一种成熟的技术，用于增加烟雾病（MMD）及其他狭窄闭塞性疾病患者的颅内血流。针对MMD与非MMD病变（N-MMD）患者接受直接EC-IC搭桥术后的结局，尚未有系统综述或荟萃分析进行比较。我们进行了一项系统综述和荟萃分析，纳入按适应证分层报告成人EC-IC搭桥术结局的研究。患者被分为MMD组或N-MMD病变组，后者主要包括颅内动脉粥样硬化性疾病（ICAD）和颅外颈动脉闭塞（CO）。结局指标包括移植物通畅率、术后卒中或颅内出血（ICH）以及过度灌注综合征（HPS）。采用随机效应模型获得各结局的合并估计值。17项研究符合纳入标准，共包括1,354例患者和1,451个半球。加权平均年龄为49.1岁，56.7%的患者为女性。搭桥适应证中，52.6%的患者为MMD或烟雾综合征（MMS）。ICAD和CO分别占患者的46.3%和3.1%。MMD组与N-MMD组的移植物通畅率无差异（OR 0.81，95% CI 0.54-1.21；I² = 0%）。术后卒中（OR 0.68，95% CI 0.33-1.41；I² = 23%）或ICH（OR 1.46，95% CI 0.34-6.26；I² = 61.4%）也无差异。N-MMD组与MMD组之间的HPS发生率无显著差异（OR 1.69，95% CI 0.67-4.26；I² = 0）。本荟萃分析发现两组在技术方面无显著差异 以及针对烟雾病与针对非烟雾病狭窄闭塞性疾病实施的直接颅外-颅内（EC-IC）搭桥手术的术后结局进行比较。需要开展大规模多中心队列研究、采用标准化技术并统一结局报告，以进一步验证这些结果。
完整摘要 · 英文原文
Extracranial-intracranial (EC-IC) bypass is an established technique to augment intracranial flow in patients with moyamoya disease (MMD) and other steno-occlusive diseases. The outcomes after direct EC-IC bypass for MMD compared to non-MMD pathologies (N-MMD) have not been systematically reviewed or compared in a meta-analysis. We performed a systematic review and meta‑analysis of studies reporting on outcomes in adults undergoing EC-IC bypass stratified by indication. Patients were assigned to either MMD or N-MMD pathologies with the latter primarily consisting of intracranial atherosclerotic disease (ICAD) and extracranial carotid occlusion (CO). Outcomes include graft patency, postoperative stroke or intracranial hemorrhage (ICH), and hyperperfusion syndrome (HPS). Random effects models were used to obtain pooled estimates for each outcome. Seventeen studies met inclusion criteria comprising 1,354 patients and 1,451 hemispheres. The weighted mean age was 49.1 years and 56.7% of patients were female. The indications for bypass included MMD or MMS in 52.6% of patients. ICAD and CO comprised 46.3% and 3.1% of patients, respectively. There was no difference in graft patency rates for the MMD and N-MMD groups (OR 0.81, 95% CI 0.54-1.21; I2 = 0%). There was also no difference in postoperative stroke (OR 0.68, 95% CI 0.33-1.41; I2 = 23%) or ICH (OR 1.46, 95% CI 0.34-6.26; I2 = 61.4%). There was no significant difference in the rate of HPS between the N-MMD and MMD groups (OR 1.69, 95% CI 0.67-4.26; I2 = 0). This meta-analysis discovered no significant differences in technical and postoperative outcomes between direct EC-IC bypass procedures performed for moyamoya and those performed for non-moyamoya steno-occlusive diseases. Further research with large multicenter cohorts, standardized techniques, and consistent outcome reporting is required to confirm these results.