微血管减压术与伽玛刀治疗原发性三叉神经痛疗效的Meta分析

Meta-analysis of the efficacy of microvascular decompression and gamma knife for primary trigeminal neuralgia

目的评价微血管减压术(MVD)与伽玛刀治疗原发性三叉神经痛(trigeminal neuralgia,TN)的疗效。方法通过电脑检索Cochrane Library、Embase、PubMed、Medline、中国知网、万方数据、维普网等中、英文数据库,时间从建库至2019年7月。选取包含MVD与伽玛刀治疗原发性TN的临床研究,采用RevMan 5.3软件进行Meta分析。结果共纳入9项回顾性研究,共计1335例病人,其中675例病人采用MVD,660例病人采用伽玛刀治疗。在治疗后1个月、6个月,MVD较伽玛刀有更高的缓解率(治疗后1个月:OR=24.78,95%CI 14.96-41.05,P<0.00001;治疗后6个月:OR=5.87,95%CI 2.70-12.76,P<0.00001)。与伽玛刀比较,MVD有更高的长期缓解率(OR=1.93,95%CI 1.32-2.84,P=0.0007)和长期治愈率(OR=4.49,95%CI 2.40-8.39,P<0.00001)。MVD比伽玛刀有更高的总并发症发生率(OR=1.45,95%CI 1.01-2.09,P=0.04),然而在术后面部麻木、听力下降、感染方面,两种治疗方式无差异。MVD较伽玛刀有更低的复发率(OR=0.35,95%CI 0.19-0.66,P=0.001)。结论与伽玛刀相比,MVD在治疗原发性TN方面,起效快且有更高的长期缓解率、长期治愈率与更低复发率,但也有较高的总并发症发生率。

Objective To evaluate the efficacy of microvascular decompression(MVD)and gamma knife for the treatment of primary trigeminal neuralgia.Methods Clinical researches on microvacular decompression(MVD)and gamma knife for primary trigeminal neuralgia were searched in Cochrane Library,Embase,Pub Med,Medline,CNKI,Wanfang and Weipu from the date of inception to July2019.The clinical literature involving MVD and gamma knife for trigeminal neuralgia was selected,and a Meta-analysis was performed using Rev Man 5.3 software.Results A total of 9 retrospective studies were included,with a total of 1335 patients,of whom 675 were treated by MVD and 660 with gamma knife.At 1 and 6 months after treatment,MVD has a higher remission rate of trigeminal neuralgia than the gamma knife(1 month after treatment:OR=24.78,95%CI 14.96-41.05,P<0.00001;6 months after treatment:OR=5.87,95%CI2.70-12.76,P<0.00001).Compared with the gamma knife,MVD had a higher long-term response rate(OR=1.93,95%CI 1.32-2.84,P=0.0007)and long-term cure rate(OR=4.49,95%CI 2.40-8.39,P<0.00001).MVD had a higher total complication rate than the gamma knife(OR=1.45,95%CI 1.01-2.09,P=0.04),but there was no difference between the two treatments in postoperative facial numbness,hearing loss and infection.MVD had a lower recurrence rate than the gamma knife(OR=0.35,95%CI 0.19-0.66,P=0.001).Conclusion Compared with the gamma knife,MVD has a more rapid effect and higher long-term remission rate,long-term cure rate and lower recurrence rate in the treatment of primary trigeminal neuralgia,but it also has a higher incidence of total complications.