| Object:This study is designed to determine whether the outcomes and complications of the patients suffering from aneurismal subarachnoid hemorrhage(SAH)differs when comparing surgical clip application with endovascular obliteration of ruptured intracranial aneurysms.Evaluate the advantages and disadvantages of the two methods from the point of view of evidence-based medicine,in order to help making clinical decision.Methods:By searching the bibliographic databases of Medline,Embase,the Cochrane,Springerlink,Elsevier,CNKI,the CBMdisc,etc.,we conducted a meta-analysis of studies that compared clipping with coiling between January 1999 and March 2016.These literatures published in the open publication,including clinical Randomized Controlled Trials(RCT),nonrandom observational studies(prospective study and retrospective study).Adopt the method of the Cochrane system evaluation,select the literatures conform to the standard by two independent evaluators,then,use the software of Review Manager 5.3 for Meta analysis.Comparison of binary outcomes between treatment groups was described using odds ratios(OR;clip versus coil).Results:(1)A total of 14 articles were included in this study.Among them,there are 2 clinical randomized controlled trials,1 prospective study and 11 retrospective studies.The sample size of these studies ranging from 98 to 2143,totally 6320 cases were included in my research.(2)The result of Meta-analysis:(Ⅰ)for postoperative vasospasm,the result of chi-square test is P﹥0.05,I2﹤50%,data showed that the group has a good homogeneity.OR,1.23;95%CI,0.77-1.95,P﹥0.05,there was no ststistically significant difference.(Ⅱ)for postoperative shunt-dependent hydrocephalus,the result of chi-square test is P﹥0.05,I2﹤50%,data showed that the group has a good homogeneity.OR,0.90;95%CI,0.70-1.15,P﹥0.05,rates did not differ significantly between different techniques.(Ⅲ)for unfavorable outcomes,the result of chi-square test is P﹤0.05,I2﹥50%,there is a high heterogeneity inthis group.OR,1.38;95%CI,1.15-1.66,P﹤0.05,the difference was statistically significant,funnel figure showed thatthere are publication bias exists.When one research is kicked out,the others showing good homogeneity,publication bias is leser also.The result of heterogeneity inspection chi-square is P﹥0.05,I2﹤50%,data shows good homogeneity.OR,1.42;95%CI,1.18-1.71,P﹤0.05,the difference was statistically significant.When random-effects model was used,the result of heterogeneity inspection chi-square is P﹤0.05,I2﹥50%,there is a high heterogeneity inthis group.OR,1.33;95%CI,0.91-1.96,P﹥0.05,there was no statistically significant difference.(Ⅳ)for aneurysm occlusion rate,the result of heterogeneity inspection chi-square test is P﹤0.05,I2﹥50%,there is a high heterogeneity in this group.After Meta-analysis,the result is OR,13.48;95%CI,9.89-18.39,P﹤0.001;when random-effects model was used,it becomes OR,10.39;95%CI,4.55-23.75,P﹤0.001,the difference was statistically significant.(Ⅴ)for the incidence of rebleeding,the result of heterogeneity inspectionchi-square test is P﹥0.05,I2﹥50%,data showed there is no good homogeneity in this group.After Meta-analysis,the result is OR,0.63;95%CI,0.42-0.95,P﹤0.05,the difference was statistically significant;when random-effects model was used,the result is OR,0.45;95%CI,0.16-1.24,P﹥0.1,there was no statistically significant difference.Conclusion:(1)The treatment method used for ruptured intracranial aneyrysms,i.e.,neurosurgical clipping or endovascular coiling,has no statistically significant effect on the development of postoperative vasospasm;(2)The treatment method used for ruptured intracranial aneyrysms,i.e.,neurosurgical clipping or endovascular coiling,has no statistically significant effect on the development of postoperative shunt-dependenthydrocephalus;(3)there is no adequate evidence to prove that the unfavorable outcomes rates in neurosurgical clipping group is higher than in endovascular coiling group;(4)the rate of aneurysm occlusion in surgical clip group is higher than in the embolization group;(5)there is no adequate evidence to prove that the rebleeding rates in neurosurgical clipping group is higher than in endovascular coiling group;(6)decisionshould be based on factors such as size and location of the aneurysm,if the two kinds of operation is both viable,should choose the method one is good at. |
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