视神经减压术治疗外伤性视神经病变有效率的Meta分析  

Effect of optic nerve decompression surgery in the treatment of traumatic optic neuropathy:A Meta-analysis

作　　者：赵燕[1] 张元杰 郭智霖[2] ZHAO Yan;ZHANG Yuanjie;GUO Zhilin(Nursing Department,Shanghai Ninth People’s Hospi-tal,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Neurosurgery,Shanghai Ninth People’s Hospi-tal,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院护理部,上海市200011 [2]上海交通大学医学院附属第九人民医院神经外科,上海市200011

出　　处：《组织工程与重建外科》2023年第4期380-390,共11页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的系统评价视神经减压术(Optic nerve decompression,OND)治疗外伤性视神经病变(Traumatic optic neuropathy,TON)的有效率。方法计算机检索PubMed、EMbase、The Cochrane Library和Web of Science等网站中,从建库到2023年2月7日的,关于OND治疗TON的回顾性研究。由两位研究人员按照纳入与排除标准对所获文献独立进行筛选、提取,使用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评定所有纳入研究的质量。结局指标为视神经减压术治疗外伤性视神经病的有效率,区间估计使用95%置信区间(Confidence interval,CI)表示,采用Stata 16.0软件对收集的数据进行Meta分析。结果最终纳入42篇文献,共3579例患者。Meta分析结果显示,OND治疗TON的总体有效率为54.2%(95%CI 49.2%~59.2%)。以不同手术入路进行亚组分析,结果显示:经眶、神经内镜经鼻和经颅入路治疗的有效率分别为56.0%(95%CI 46.2%~65.7%)、52.8%(95%CI 45.1%~60.5%)和50.0%(95%CI 36.1%~63.9%)。伤后≤7 d和>7 d手术减压有效率分别为69.5%(95%CI 55.0%~82.5%)、28.6%(95%CI 21.4%~36.2%);伤后1~2 d手术和3~7 d手术减压有效率分别为71.5%(95%CI 45.2%~92.3%)、51.2%(95%CI 65.3%~100.0%)。术前有、无光感患者的有效率分别为79.2%(95%CI 84.6%~100.0%)、36.3%(95%CI 30.2%~42.6%)。切开视神经鞘联合OND的总体有效率为40.7%(95%CI 27.0%~55.1%)。结论OND是改善TON患者视力的有效方法,不同手术方式相差不大,经眶手术减压有效率最高;手术时机应尽早,术前有光感患者预后较好,术中切开视神经鞘可能对患者的视力恢复有帮助。Objective To systematically evaluate the efficacy of optic nerve decompression(OND)in the treatment of traumatic optic neuropathy(TON).Methods A computer search was conducted for the retrospective studies on OND in the treatment of TON in PubMed,EMbase,The Cochrane Library and Web of Science from database establishment to February 7,2023.The obtained studies were independently screened and extracted by two researchers according to inclusion and exclusion criteria,and their quality was assessed using the Newcastle-Ottawa Scale(NOS).The postoperative outcomes were considered to indicate the efficiency of OND for TON.Interval estimates were expressed using a 95%confidence interval(CI),and the meta-analysis of the collected data was performed using Stata 16.0 software.Results A total of 42 studies,including 3,579 patients,were finally included.The results of the meta-analysis were as follows:The overall efficiency of OND for TON was 54.2%(95%CI 49.2%-59.2%).Subgroup analysis with different surgical approaches showed that the efficiency of endoscopic transorbital,transnasal,and transcranial approaches for TON was 56.0%(95%CI 46.2%-65.7%),52.8%(95%CI 45.1%-60.5%),and 50.0%(95%CI 36.1%-63.9%),respectively.The efficiency of OND≤7 and>7 days post-injury was 69.5%(95%CI 55.0%-82.5%)and 28.6%(95%CI 21.4%-36.2%),respectively,whereas 1-2 and 3-7 days post-injury,it was 71.5%(95%CI 45.2%-92.3%)and 51.2%(95%CI 65.3%-100.0%),respectively.The OND efficiency with and without light perception was 79.2%(95%CI 84.6%-100.0%)and 36.3%(95%CI 30.2%-42.6%),respectively.The overall efficiency of optic nerve sheath incision along with optic canal decompression was 40.7%(95%CI 27.0%-55.1%).Conclusion OND is an effective method to improve vision in patients with TON.The difference in preoperative characteristics was not significant among different surgical methods.The transorbital approach showed the most favorable postoperative outcomes.The time of surgery should be as early as possible,and patients with preoperative light perception have

关 键 词：视神经减压 外伤性视神经损伤 经颅入路视神经减压 内镜下经鼻视神经减压 眶内翼间隔窦视神经减压 

分 类 号：R774.6[医药卫生—眼科]