神经内镜术与传统开颅术治疗高血压脑出血疗效比较的meta分析  

A meta-analysis of the comparison between neuroendoscopy and traditional craniotomy in the treatment of hypertensive cerebral hemorrhage

作　　者：宋飞 张毅 廖卜生 陈旭 SONG Fei;ZHANG Yi;LIAO Busheng;CHEN Xu(Graduate School of Shaanxi University of Traditional Chinese Medicine,Xianyang,Shaanxi 712000,China;Department of Brain Surgery,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang,Shaanxi 712000,China)

机构地区：[1]陕西中医药大学研究生院,陕西咸阳712000 [2]陕西中医药大学附属医院脑外科,陕西咸阳712000

出　　处：《重庆医学》2021年第20期3531-3535,3540,共6页Chongqing medicine

基　　金：国家自然科学基金项目(81873288);陕西省中医脑病临床医学研究中心建设项目(2019SF-309);陕西中医药大学学科创新团队建设项目(2019-YL15);陕西省中医管理局中医药科研课题(JCPT025);陕西省中医药重点研究室建设项目(陕中医药发〔2018〕32号)。

摘　　要：目的系统评价神经内镜术与传统开颅术治疗高血压脑出血(HICH)的临床疗效。方法计算机检索2015—2020年的CNKI、万方、PubMed和维普(VIP)数据库及中国生物文献数据库(CBM),搜集对比神经内镜术和传统开颅术治疗高血压脑出血的文献,并通过RevMan 5.3软件对纳入所需文献进行meta分析。结果共纳入10个研究,其中353例行神经内镜术治疗,386例行传统开颅术治疗。Meta分析结果显示:与传统开颅组比较,神经内镜组手术时间更短(MD=-126.86,95%CI:-183.32~-70.39,P<0.001)、术中出血量更少(MD=-237.49,95%CI:-306.21~-168.76,P<0.001)、血肿清除率更高(MD=8.27,95%CI:1.79~14.75,P<0.001)、术后并发症发生率更低(OR=0.23,95%CI:0.13~0.40,P<0.001)、住院时间缩短(MD=-6.08,95%CI:-9.30~-2.86,P<0.001)、术后1周格拉斯哥昏迷(GCS)评分更高(MD=1.92,95%CI:0.76~3.07,P<0.001);两者在术后病死率上差异无统计学意义(OR=0.44,95%CI:0.18~1.07,P=0.070)。结论相较于传统开颅术,神经内镜术可有效缩短HICH患者手术时间、降低术中出血量、提高血肿清除率、缩短住院时间、并可有效提高术后1周的GCS评分,但两种术式在术后病死率方面无明显差异。Objective To systematically evaluate the clinical efficacy of neuroendoscopy and conventional craniotomy in the treatment of hypertensive intracerebral hemorrhage.Methods A computer-based search of CNKI,Wanfang database,China Biomedical Literature Database(CBM),PubMed and VIP database were conducted from 2015 to 2020,and the literatures on contrasting neuroendoscopy and conventional craniotomy in the treatment of hypertensive intracerebral haemorrhage were collected.Meta-analysis of the included literature was performedby by using RevMan 5.3 software.Results A total of 10 studies were included,of which 353 cases were treated with neuroendoscopy and 386 cases were treated with conventional craniotomy.Meta-analysis results showed that compared with the conventional craniotomy group,the neuroendoscopy group had shorter operative time[MD=-126.86,95%CI:-183.32 to-70.39,P<0.001],less intraoperative blood loss[MD=-237.49,95%CI:-306.21 to-168.76,P<0.001],higher hematoma clearance rate[MD=8.27,95%CI:1.79 to 14.75,P<0.001],lower postoperative complication rate[OR=0.23,95%CI:0.13 to 0.40,P<0.001],shorter hospital stay[MD=-6.08,95%CI:-9.30 to-2.86,P<0.001],and higher GCS scores at one week postoperatively[MD=1.92,95%CI:0.76 to 3.07,P<0.001].There was no statistically significant difference in the postoperative mortality between the two groups[OR=0.44,95%CI:0.18 to 1.07,P=0.070].Conclusion Compared with the conventional craniotomy,the neuroendoscopy can effectively shorten the operation time,reduce intraoperative blood loss,improve the haematoma clearance rate,shorten the hospital stay and effectively improve the GCS scores at one week postoperatively.However,there is no significant difference in the postoperative mortality between the two methods.

关 键 词：高血压脑出血 神经内镜术 传统开颅术 META分析 

分 类 号：R651.12[医药卫生—外科学]