摘要
目的比较神经内镜手术和显微镜手术治疗高血压性基底节区出血的临床疗效。方法检索PubMed、Cochrane Library、Embase、维普网、CNKI、CBM以及万方数据库，查找所有比较神经内镜手术和显微镜手术治疗高血压性基底节脑出血的随机对照试验和半随机对照试验，检索时限为建库至2015年10月31日。对所检出的文献进行筛选、资料提取后，以RevMan5．3软件进行Meta分析，并采用GRADE系统进行证据质量评价。结果最终纳入9项研究，共700例患者。Meta分析结果显示：（1）在安全性方面：与显微镜组相比，内镜组血肿清除率更高（SMD=0．63，95％CI：0．30-0．95，P〈0．001），手术时间更短（SMD=-2．66，95％CI：-3．71--1．60，P〈0．001），住院时间更短（SMD=-0．72，95％CI：-1．01--0．44，P〈0．001），术后并发症更少（RR=0．56，95％CI：0．40-0．77，P〈0．001）。在术中出血量、住院费用方面两组的差异均无统计学意义（均P〉0．05）。（2）在有效性方面：与显微镜组相比，内镜组预后更佳（RR=1．15，95％CI：1．03-1．27，P=0．002），病死率更低（RR=0．57，95％CI：0．22-1．00，P=0．05）。结论与显微镜手术相比，神经内镜手术治疗高血压性基底节区出血其预后更佳、病死率更低，疗效更好；并且后者手术清除率更高，手术时间更短，术后并发症更少，安全性更高。但因原始研究的质量均较低，需要更多高质量、大样本的随机对照试验进一步论证。
Objective To compare the clinical efficacy of neuroendoscopy and microsurgery for the treatment of hypertensive basal ganglia hemorrhage. Methods PubMed, Cochrane Library, Embase, VIP, CNKI, CBM and Wanfang database were retrieved. The randomized controlled trials and semi- randomized controlled trials comparing all the basal ganglia hemorrhage treated with neuroendoscopy and mierosurgery were searched. The retrieval time was from the establishment of the database to October 31, 2015. After the detected literature being screened, extracted and evaluated, a Meta-analysis was performed using RevMan 5.3 software, and the GRADE system was used to conduct the quality evaluation of evidence. Results Finally, A total of 9 trials with 700 patients were enrolled. The results of Meta-analysis showed： （ 1 ） in the aspect of safety ： compared with the microscope group, the hematoma clearance rate was higher （SMD = 0.63, 95% CI O. 30 - 0.95, P 〈 0. 001 ） , operation time was shorter （ SMD = - 2.66, 95% CI -3.71 - -1.60, P〈0.001）, hospitalization time was shorter （SMD= -0.72, 95% CI -1.01 - - 0. 44, P 〈 0.001 ） , and postoperative complications were less （ RR = 0.56, 95% CI 0. 40 - 0.77, P 〈 0. 001 ） of the neuroendoseopy group. There were no significant differences in the intraoperative bleeding and hospital cost between the 2 groups （ all P 〈 0.05 ）. （ 2 ） In the aspect of effectiveness： compared with the microsurgery group, the prognosis was better （ RR = 1.15, 95% CI 1.03 - 1.27 ; P = 0.002） and the mortality was lower （RR = 0.57, 95% CI 0.22 - 1.00 ; P = 0.05 ） in the neuroendoscope group. Conclusions Compared with the microsurgery, the prognosis of neuroendoscopy is better, the mortality is lower, the efficacy is better, and the surgical removal rate of the latter is higher, the operation time is shorter, the postoperative complications are less, and the safety is higher. But because of the quality of the original research is lower, the prudent choice and use in clinical practice ARE recommended. More high quality, large sample randomized controlled trials are needed for further argument.
出处
《中华神经外科杂志》
CSCD
北大核心
2016年第11期1162-1168,共7页
Chinese Journal of Neurosurgery
