[1]李强,施炜,张恒柱,等.神经内镜对比脑室外引流治疗脑室出血的荟萃分析[J].临床神经外科杂志,2019,16(06):500-506.[doi:10.3969/j.issn.1672-7770.2019.06.009]
 LI Qiang,SHI Wei,ZHANG Heng-zhu,et al.Meta-analysis of neuroendoscopy versus external ventricular drainage in treatment of intraventricular hemorrhage[J].Journal of Clinical Neurosurgery,2019,16(06):500-506.[doi:10.3969/j.issn.1672-7770.2019.06.009]
点击复制

神经内镜对比脑室外引流治疗脑室出血的荟萃分析()
分享到:

《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
16
期数:
2019年06期
页码:
500-506
栏目:
脑出血专题
出版日期:
2019-12-03

文章信息/Info

Title:
Meta-analysis of neuroendoscopy versus external ventricular drainage in treatment of intraventricular hemorrhage
作者:
李强施炜张恒柱李育平顾建华白吉南葛爱亮杨德福
225200 扬州,苏北人民医院东院神经外科(李强,顾建华,白吉南,葛爱亮,杨德福);南通大学附属医院神经外科(施炜);苏北人民医院神经外科(张恒柱,李育平)
Author(s):
LI Qiang SHI Wei ZHANG Heng-zhu et al.
Department of Neurosurgery, East District of Subei People’s Hospital, Yangzhou 225200, China
关键词:
神经内镜脑室出血脑室外引流Meta分析
Keywords:
neuroendoscopy external ventricular drainage intraventricular hemorrhage meta-analysis
分类号:
R743.34
DOI:
10.3969/j.issn.1672-7770.2019.06.009
文献标志码:
A
摘要:
【摘要】目的 系统性评价神经内镜(NE)对比脑室外引流(EVD)治疗脑室出血的有效性及安全性,为临床工作提供依据。方法利用相关关键词在中国知网(CNKI)、万方数据库、维普网(VIP)、Cochrane临床试验数据库、PubMed、EMbase等中英文数据库中进行检索,纳入有关神经内镜对比脑室外引流治疗脑室出血的随机及非随机对照研究。使用 RevMan 5.3软件对数据进行合并分析;并对设计类型、随访时间及术前时间进行亚组分析。结果 最终纳入19篇文献(共1 269例患者),包括9篇随机对照研究和10篇非随机对照研究。Meta分析结果显示,神经内镜组的有效血肿清除率明显高于脑室外引流组(OR=22.30, 95% CI:14.35~34.64,P<0.000 01);良好功能恢复率优于脑室外引流组(OR=3.07,95% CI:2.26~4.17,P<0.000 01),患者的死亡率明显降低(OR=0.48,95% CI:0.32~0.71,P=0.000 3)。两组并发症发生率比较,神经内镜组的颅内感染率(OR=0.19,95% CI:0.09~0.43,P<0.000 1)、术后再出血率(OR=0.22,95% CI:0.08~0.65,P=0.006)和脑积水发生率(OR=0.16,95% CI:0.11~0.25,P<0.000 01)均显著低于脑室外引流组。亚组分析显示,随访时间、术前时间及尿激酶的使用均可能为影响患者死亡率的重要因素。结论神经内镜治疗脑室出血可能比传统的脑室外引流术更加安全有效。
Abstract:
Abstract: ObjectiveThe effectiveness and safety of neuroendoscopy(NE) versus external ventricular drainage(EVD) in the treatment of intraventricular hemorrhage was systematically evaluated, which provided a basis for clinical work. MethodsThe relevant search terms were used to search randomized and non-randomized controlled studies in Chinese and English databases(including CNKI, Wanfang, VIP, the Cochrane Library, PubMed, EMbase). The data was combined and analyzed using RevMan 5.3 software. Subgroup analysis was performed on the type of design, follow-up time, and preoperative time. ResultsA total of 19 articles(1 269 patients) were included(9 randomized controlled trials and 10 non-randomized controlled trials). Meta-analysis showed that NE group could increase the effective hematoma clearance rate(OR=22.30, 95% CI:14.35-34.64,P<0.000 01), improve the good functional outcome(OR=3.07,95% CI:2.26-4.17,P<0.000 01) and reduce patient mortality(OR=0.48,95% CI:0.32-0.71,P=0.000 3) significantly when compared with EVD group. In terms of complication incidence, the intracranial infection rate(OR=0.19, 95% CI:0.09-0.43,P<0.000 1), postoperative rebleeding rate(OR=0.22,95% CI:0.08-0.65,P=0.006) and the incidence of hydrocephalus(OR=0.16,95% CI:0.11 to 0.25,P<0.000 01) in the NE group were significantly lower than that in the EVD group. Subgroup analysis showed follow-up time, preoperative time, and use of urokinase may be important factors influencing patients’ mortality. ConclusionNE may be safer and more effective in treating ventricular hemorrhage than EVD.

相似文献/References:

[1]佘磊,李育平,张恒柱,等.神经内镜锁孔入路与传统开颅术治疗颅内血肿的对比研究[J].临床神经外科杂志,2014,(01):33.
[2]徐成伟,朱宏伟,高乃康,等.142例鞍区占位病变手术治疗总结[J].临床神经外科杂志,2014,(01):51.
[3]马俊伟,蒋栋毅,陈寒春,等.神经内镜下经鼻蝶入路垂体腺瘤手术切除的临床疗效分析[J].临床神经外科杂志,2015,(01):48.
[4]张红波,陈谦学,穆林森.斜坡异位泌乳素垂体腺瘤1例临床分析并文献复习[J].临床神经外科杂志,2016,(01):16.
[5]荣道建,杨晓健,赵俊伟.神经内镜辅助原发性三叉神经显微血管减压术[J].临床神经外科杂志,2015,(02):89.
[6]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,(04):265.
[7]颉奎,祝斐,黄新,等.合并脑室出血的高级别前交通动脉瘤超早期显微手术治疗[J].临床神经外科杂志,2015,(05):321.
[8]杨平来,张源源,周立正.微创脑室外引流术治疗39例脑室出血疗效分析[J].临床神经外科杂志,2015,(05):378.
[9]张元隆,江常震,王晨阳.经额开颅手术后额窦炎的处理[J].临床神经外科杂志,2015,(05):380.
[10]耿鑫.CT引导内窥镜立体定向术治疗颅内病变的临床研究[J].临床神经外科杂志,2014,(02):122.
[11]任峰,卞杰勇,王晓军,等.内镜手术治疗脑室出血伴脑室铸型的疗效分析[J].临床神经外科杂志,2019,16(5):454.[doi:10.3969/j.issn.1672-7770.2019.05.019]
 REN Feng,BIAN Jie-yong,WANG Xiao-jun,et al.Analysis of endoscopic microsurgery combined with external ventricular drainage plus ICP monitoring for severe ventricular hemorrhage[J].Journal of Clinical Neurosurgery,2019,16(06):454.[doi:10.3969/j.issn.1672-7770.2019.05.019]

更新日期/Last Update: 2019-12-10