腰大池-腹腔分流术与脑室-腹腔分流术治疗非梗阻性脑积水的Meta分析  

A Meta-analysis on lumbo-peritoneal shunt versus ventriculoperitoneal shunt for non-obstructive hydrocephalus

作　　者：汪乐生 文嘉宇 王声播 周克垚 陈劲草[1] WANG Le-sheng;WEN Jia-yu;WANG Sheng-bo(Department of Neurosurgery,Zhongnan Hospital Affiliated to Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院神经外科,武汉430071

出　　处：《临床神经外科杂志》2021年第5期562-568,共7页Journal of Clinical Neurosurgery

基　　金：湖北省技术创新重大专项基金资助项目(2018ACA139)。

摘　　要：目的研究非梗阻性脑积水的常用治疗方法腰大池-腹腔分流术(LP)和脑室-腹腔分流术(VP)的安全性及有效性。方法检索三大英文数据库Pub Med、Embase、Cochrane Library和三大中文数据库CNKI、WANFANG DATA、VIP,查找有关LP和VP治疗非梗阻性脑积水的所有临床研究文献,检索时间为建库至2020年4月20日。按预先制定的纳入及排除标准筛选出目标文献,对目标文献进行质量评估和数据提取,并用Rev Man 5.3软件进行Meta分析。结果共纳入16项随机对照研究,2070例患者。与VP治疗组相比,LP治疗组的总体并发症发生率(RR=0.55,95%CI 0.34~0.90,P=0.02)、术后感染率(RR=0.45,95%CI 0.26~0.78,P=0.005)及术后引流不当发生率(RR=0.48,95%CI 0.24~0.97,P=0.04)均明显降低。但是两组的有效率、堵管、癫痫和颅内出血发生率比较,差异均无统计学意义。结论与非梗阻性脑积水VP治疗相比,LP治疗能够明显降低总体并发症、术后感染和术后引流不当的发生率。但两种治疗方式在有效率及术后堵管、癫痫、颅内出血发生率方面无显著差异。Objective To study the safety and efficacy of lumbo-peritoneal shunt(LP)and ventriculoperitoneal shunt(VP),which were commonly used in the treatment of non-obstructive hydrocephalus.Methods Three English databases(Pub Med,EMbase,and the Cochrane Library)and three Chinese databases(CNKI,Wanfang,and VIP)were searched by the computer to find the clinical trials of the two treatments from the establishment to April 20,2020.Screening all clinical researches based on pre-determined inclusion criteria and exclusion criteria,authors conducted the quality assessment and data extraction of targeted articles.Meta-analysis was performed by using Revman 5.3 software.Results A total of 16 randomized controlled clinical trials involving 2070 subjects were included.Compared with VP in the treatment of non-obstructive hydrocephalus,LP could significantly lower the incidence of total complications[RR=0.55,95%CI(0.34,0.90),P=0.02],the incidence of postoperative infection[RR=0.45,95%CI(0.26,0.78),P=0.005],and the incidence of improper drainage[RR=0.48,95%CI(0.24,0.97),P=0.04].There was no significant difference in the effectiveness,shunt block,epilepsy and intracranial hemorrhage between the two groups.Conclusions Compared with VP for non-obstructive hydrocephalus,LP can significantly lower the incidence of total complications,postoperative infection,and improper drainage.There is no statistical significance in the effectiveness,shunt block,epilepsy,and intracranial hemorrhage.

关 键 词：非梗阻性脑积水 腰大池-腹腔分流术 脑室-腹腔分流术 META分析 

分 类 号：R651.1[医药卫生—外科学]