可调压分流管置入治疗脑积水疗效的系统评价  

Effectiveness of Programmable Valves for Hydrocephalus: A Systematic Review

作　　者：徐昊[1] 王占祥[1] 陈东汉[1] 张绍林[1] 郭剑锋[1] 谭国伟[1] 陈四方[1] 朱宏伟[1] 

机构地区：[1]厦门大学附属第一医院神经外科,厦门361022

出　　处：《中国循证医学杂志》2013年第1期78-85,共8页Chinese Journal of Evidence-based Medicine

基　　金：福建省自然科学基金面上项目(编号:2009D002)

摘　　要：目的系统评价可调压分流管置入治疗脑积水的疗效和安全性。方法计算机检索PubMed、Cochrane图书馆、EMbase、CNKI、CBM、VIP和WanFang Data,收集可调压分流管与常规非可调压分流管置入比较治疗脑积水的随机对照试验或非随机的同期对照试验,检索时限从1992年1月至2012年1月。由2名研究者按照纳入标准独立筛选文献、提取资料、评价质量并交叉核对后,采用RevMan5.0软件进行Meta分析。结果纳入11个非随机的同期对照试验,共1 485例患者。Meta分析结果显示:可调压分流管在总体有效率[RR=1.14,95%CI(1.03,1.27),P=0.01]、2年生存率[RR=1.25,95%CI(1.04,1.51),P=0.02]、二次手术换管率[RR=0.53,95%CI(0.39,0.73),P<0.001]、总并发症发生率[RR=0.62,95%CI(0.51,0.76),P<0.001]和分流过度或不足发生率[RR=0.42,95%CI(0.21,0.83),P=0.01]方面均优于常规非可调压分流管,其差异有统计学意义;但在1年生存率[RR=1.04,95%CI(0.91,1.19),P=0.55]、术后感染率[RR=1.08,95%CI(0.73,1.60),P=0.71]和分流管相关并发症[RR=0.80,95%CI(0.56,1.21),P=0.20]方面,两组差异无统计学意义。结论现有证据提示可调压分流管在增加分流有效率、减少分流并发症和延长患者远期生存率方面存在优势。受纳入研究数量和质量限制,还需要开展更多高质量的多中心随机双盲对照试验进一步验证其能否作为分流手术首选在临床推广。Objective To systematically review the clinical effectiveness and safety of programmable valves （PV） vs. standard valves （SV） for hydrocephalus. Methods Literature search was conducted in PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP and WanFang Data to collect both randomized controlled trials （RCTs） and non-randomized concurrent controlled trials on hydrocephalus treated by PV and SV published from January 1992 to January 2012. Ac- cording to the inclusion criteria, two reviewers independently screened articles, extracted data, and evaluated and cross- checked the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 11 non-randomized concurrent controlled trials involving 1,485 participants were included. The results of metaanalysis showed that, compared with SV, PV was superior in overall effective rate （RR=1.14, 95%CI 1.03 to 1.27, P=0.01）, 2-year survival rate （RR=1.25, 95%CI 1.04 to 1.51, P=0.02）, secondary surgery rate （RR=0.53, 95%CI 0.39 to 0.73, P〈0.001）, overall complications rate （RR=0.62, 95%CI 0.51 to 0.76, P〈0.001）, and over-drainage/under-drainage rates （RR=0.42, 95%CI 0.21 to 0.83, P=0.01）. But there were no significant differences in 1-year survival rate （RR=I.04, 95%CI 0.91 to 1.19, P=0.55）, postoperative infection rate （RR=I.08, 95%CI 0.73 to 1.60, P=0.71） and valve related complication rate （RR=0.80, 95%CI 0.56 to 1.21, P=0.20） between the two groups. Conclusion Current evidence suggests that PV is superior to SV in increasing the effective rate, decreasing complications, and prolonging the long-term survival rate. Because of the limitation of quantity and quality of the included studies, more high quality, multicenter and double-blind RCTs are needed to prove whether PV can be clinically recommended as a preferred drainage surgery or not.

关 键 词：脑积水 脑室腹腔分流术 可调压分流管 常规非可调压分流管 系统评价 META分析 

分 类 号：R651.1[医药卫生—外科学]