Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China.
Department of Cardiology, Xinqiao Hospital of Third Military Medical University, Chongqing, 400038 China.
Mil Med Res. 2017 May 30;4:17. doi: 10.1186/s40779-017-0125-6. eCollection 2017.
Splenic artery embolization (SAE) has been an effective adjunct to the Non-operative management (NOM) for blunt splenic injury (BSI). However, the optimal embolization techniques are still inconclusive. To further understand the roles of different embolization locations and embolic materials in SAE, we conducted this system review and meta-analyses.
Clinical studies related to SAE for adult patients were researched in electronic databases, included PubMed, Embase, ScienceDirect and Google Scholar Search (between October 1991 and March 2013), and relevant information was extracted. To eliminate the heterogeneity, a sensitivity analysis was conducted on two reduced study sets. Then, the pooled outcomes were compared and the quality assessments were performed using Newcastle-Ottawa Scale (NOS). The SAE success rate, incidences of life-threatening complications of different embolization techniques were compared by test in 1st study set. Associations between different embolization techniques and clinical outcomes were evaluated by fixed-effects model in 2nd study set.
Twenty-three studies were included in 1st study set. And then, 13 of them were excluded, because lack of the necessary details of SAE. The remaining 10 studies comprised 2nd study set, and quality assessments were performed using NOS. In 1st set, the primary success rate is 90.1% and the incidence of life-threatening complications is 20.4%, though the cases which required surgical intervention are very few (6.4%). For different embolization locations, there was no obvious association between primary success rate and embolization location in both 1st and 2nd study sets ( > 0.05). But in 2nd study set, it indicated that proximal embolization reduced severe complications and complications needed surgical management. As for the embolic materials, the success rate between coil and gelfoam is not significant. However, coil is associated with a lower risk of life-threatening complications, as well as less complications requiring surgical management.
Different embolization techniques affect the clinical outcomes of SAE. The proximal embolization is the best option due to the less life-threatening complications. For commonly embolic material, coil is superior to gelfoam for fewer severe complications and less further surgery management.
脾动脉栓塞术（SAE）已成为非手术治疗（NOM）钝性脾损伤（BSI）的有效辅助手段。然而，最佳的栓塞技术仍存在争议。为了进一步了解不同栓塞部位和栓塞材料在 SAE 中的作用，我们进行了系统评价和荟萃分析。
在电子数据库中检索与成人 SAE 相关的临床研究，包括 PubMed、Embase、ScienceDirect 和 Google Scholar Search（1991 年 10 月至 2013 年 3 月），并提取相关信息。为了消除异质性，对两个简化的研究集进行了敏感性分析。然后，对汇总结果进行比较，并使用纽卡斯尔-渥太华量表（NOS）进行质量评估。在第一个研究集中，通过 检验比较不同栓塞技术的 SAE 成功率和不同栓塞技术的危及生命并发症发生率。在第二个研究集中，使用固定效应模型评估不同栓塞技术与临床结局的关系。
第一个研究集中纳入了 23 项研究。然后，其中 13 项研究因缺乏 SAE 必要的详细信息而被排除。其余 10 项研究构成了第二个研究集，并使用 NOS 进行了质量评估。在第一个研究集中，原发性成功率为 90.1%，危及生命并发症的发生率为 20.4%，但需要手术干预的病例非常少（6.4%）。对于不同的栓塞部位，在第一个和第二个研究集中，原发性成功率与栓塞部位之间均无明显相关性（>0.05）。但在第二个研究集中，近端栓塞可减少严重并发症和需要手术治疗的并发症。对于栓塞材料，线圈和明胶海绵之间的成功率没有显著差异。然而，线圈与危及生命的并发症风险较低以及需要手术治疗的并发症较少相关。
不同的栓塞技术影响 SAE 的临床结局。由于危及生命的并发症较少，近端栓塞是最佳选择。对于常用的栓塞材料，线圈在严重并发症和进一步手术管理方面优于明胶海绵。
Zotero 插件
