全内镜下和显微镜下显微血管减压术治疗原发性三叉神经痛疗效的Meta分析  

Meta-analysis of efficacy of complete endoscopic and microscopic microvascular decompression in primary trigeminal neuralgia

作　　者：张锋 司凯闯 郑鲁 赵中甫 ZHANG Feng;SI Kai-chuang;ZHENG Lu;ZHAO Zhong-fu(Department of Neurosurgery,Xuchang Central Hospital,Xuchang,Henan 461000,China)

机构地区：[1]许昌市中心医院神经外科,河南许昌461000

出　　处：《医药论坛杂志》2023年第6期61-64,共4页Journal of Medical Forum

基　　金：2019年度许昌市科技计划项目(20190213216)。

摘　　要：目的使用Meta分析评价全内镜下显微血管减压术(endoscopic microvascular decompression,E-MVD)和显微镜下显微血管减压术(microscopic microvascular decompression,M-MVD)在原发性三叉神经痛治疗中的有效性和安全性。方法检索中国知网(CNKI)、万方数据库、VIP中文期刊服务平台、中国生物医学文献服务系统(CBM)、Web of science、Pubmed、Cochrane Library、EMBASE自建库到2022年5月公开发表的关于显微血管减压术治疗PTN的中英文文献,提取试验组采用全内镜下治疗,对照组采用显微镜下治疗的数据,采用NOS量表进行文献质量评估,并按照Cochrane系统评价员学习手册进行Meta分析。结果共纳入7项研究,其中中文5项,英文2项,均为高质量文献(NOS评分≥6分)。Meta分析结果提示:两组手术时间差异有统计学意义(MD=9.25,Z=2.55,P=0.01);两组术后1年内总有效率差异有统计学意义(RR=1.07,95%CI[1.02,1.12],P=0.003);两组术后1年内痊愈率差异有统计学意义(RR=1.26,95%CI[1.13,1.40],P<0.0001);因纳入研究间的异质性较大,对两组术后手术并发症发生率进一步行敏感性分析,两组术后手术并发症发生率差异有统计学意义(RR=0.39,95%CI[0.26,0.60],P<0.0001)。结论本文结果表明,与M-MVD相比,E-MVD对原发性三叉神经痛治疗效果更好,术后并发症更少,安全性更高。Objective To evaluate the efficacy and safety of microvascular decompression under complete endoscope(E-MVD)or microscope(M-MVD)for primary trigeminal neuralgia by Meta-analysis method.Methods The databases of China National Knowledge Infrastructure(CNKI),Wanfang,VIP Chinese Journal Service Platform,China Biomedical Literature Service System(CBM),Web of science,Pubmed,Cochrane Library,EMBASE were searched for publishing literature on microvascular decompression for primary trigeminal neuralgia from the construction of the library to May 2022.Extracting data which includes the test group with full endoscopic treatment and the control group with microscopic treatment.The NOS scale was used to assess literature quality,and statistical analysis were conducted by Review Manager 5.3 software according to Cochrane Handbook for meta analysis.Results A total of 7 studies were included,including 5 in Chinese and 2 in English,which were high quality literature(NOS score≥6).The results of Meta-analysis indicated that the difference of the operation time between the two groups was significant(MD=9.25,Z=2.55,P=0.01).The total effective rate difference within 1 year between the two groups was significant(RR=1.07,95%CI[1.02,1.12],P=0.003).The cure rate difference within 1 year between the two groups was significant(RR=1.26,95%CI[1.13,1.40],P<0.0001).Due to the large heterogeneity between the included studies,sensitivity analysis were further performed for surgical complication rate,the surgical complication rate between the two groups has significant difference(RR=0.39,95%CI[0.26,0.60],P<0.0001).Conclusion The results presented here show that E-MVD works better for primary trigeminal neuralgia,with fewer surgical complications and a higher safety profile when compared with M-MVD.

关 键 词：原发性三叉神经痛 显微血管减压术 内镜 显微镜 META分析 

分 类 号：R745.1[医药卫生—神经病学与精神病学]