Qian Cong, Yu Xiaobo, Li Jianru, Chen Jingyin, Wang Lin, Chen Gao
From the Department of Neurological Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Medicine (Baltimore). 2015 Dec;94(49):e2218. doi: 10.1097/MD.0000000000002218.
The treatment of moyamoya disease (MMD) is controversial and often depends on the doctor's experience. In addition, the choice of surgical procedure to treat MMD can differ in many ways. In this study, we performed a meta-analysis to determine whether surgical treatment of MMD is superior to conservative treatment and to provide evidence for the selection of an appropriate surgical treatment.The human case-control studies regarding the association of MMD treatment were systematically identified through online databases (PubMed, Web of Science, Elsevier Science Direct, and Springer Link). Inclusion and exclusion criteria were defined for the eligible studies. The fixed-effects model was performed when homogeneity was indicated. Alternatively, the random-effects model was utilized.This meta-analysis included 16 studies. Surgical treatment significantly reduced the risk of stroke (odds ratio (OR) of 0.17, 95% confidence interval (CI), 0.12-0.26, P < 0.01). A subgroup analysis showed that surgical treatment was more beneficial to hemorrhagic MMD (OR of 0.23, 95% CI, 0.15-0.38, P < 0.01), but there was no significant difference between surgical treatment and conservative treatment on ischemic MMD treatment (OR of 0.45, 95% CI, 0.15-1.29, P = 0.14). Further analysis indicated that compared to direct bypass surgery, indirect bypass surgery had a lower efficacy on secondary stroke risk reduction (OR of 1.79, 95% CI, 1.14-2.82, P = 0.01), while no significant difference was detected for perioperative complications.Surgery is an effective treatment for symptomatic MMD patients, and direct bypass surgery may bring more benefits for these patients.
烟雾病（MMD）的治疗存在争议，且往往取决于医生的经验。此外，治疗MMD的手术方式选择在很多方面可能有所不同。在本研究中，我们进行了一项荟萃分析，以确定MMD的手术治疗是否优于保守治疗，并为选择合适的手术治疗提供依据。通过在线数据库（PubMed、Web of Science、Elsevier Science Direct和Springer Link）系统地识别了关于MMD治疗关联的人类病例对照研究。为符合条件的研究定义了纳入和排除标准。当显示出同质性时，采用固定效应模型。否则，使用随机效应模型。这项荟萃分析包括16项研究。手术治疗显著降低了中风风险（优势比（OR）为0.17，95%置信区间（CI）为0.12 - 0.26，P＜0.01）。亚组分析表明，手术治疗对出血性MMD更有益（OR为0.23，95%CI为0.15 - 0.38，P＜0.01），但在缺血性MMD治疗中，手术治疗与保守治疗之间没有显著差异（OR为0.45，95%CI为0.15 - 1.29，P = 0.14）。进一步分析表明，与直接搭桥手术相比，间接搭桥手术在降低继发性中风风险方面疗效较低（OR为1.79，95%CI为1.14 - 2.82，P = 0.01），而围手术期并发症方面未检测到显著差异。手术是有症状MMD患者的有效治疗方法，直接搭桥手术可能给这些患者带来更多益处。
