小骨窗血肿清除术与微创血肿穿刺术治疗高血压脑出血的疗效比较

The comparison of key hole and minimally invasive puncture approach in the management of hypertensive cerebral hematoma:A systematic review

目的比较小骨窗血肿清除术与微创血肿穿刺术治疗高血压脑出血的疗效。方法按照系统评价的要求全面检索万方全文数据库(数字化期刊和学位论文数据库)、维普中文科技期刊全文数据库、中国知网及CBMdisc数据库,纳入10个随机对照研究,共计1937例患者(小骨窗组959例,微创穿刺组978例),Meta分析远期预后及死亡率。结果小骨窗血肿清除术组与微创穿刺术组比较,患者远期预后有效率差异无统计学意义[P=0.84,OR合并=0.98,95%CI(0.80～1.20)],两组死亡率差异无统计学意义[P=0.15,OR合并=0.81,95%CI(0.62～1.08)]。结论小骨窗血肿清除术与微创血肿穿刺手术治疗高血压脑出血都是有效的。

Objective To evaluate the efficacy of two different surgical approaches-key hole and minimally invasive puncture approach in the management of hypertensive cerebral hematoma.Methods According to the essentials of systematic review,a thorough literature search was performed among Wanfang Fulltext Database,Vip Fulltext Databse,Chinese Digital Hospital Library and Chinese Biomedical Literature Disk Database（CBMdisk）.A meta analysis was performed on a total of 1937 cases involved in 10 papers which met the inclusion criteria.Results Publication bias had little influence on Meta analysis.Test for heterogeneity showed that no heterogeneity existed among the including papers,which allowed to use fixed effect model analysis.Incorporation analysis showed that the odd ratios were 0.98,0.81,respectively,and 95% CIs were [0.80,1.20],[0.62,1.08] on test for good outcome and mortality rate.No difference existed between the two approaches as rate of good outcome and mortality are concerned.Conclusion The clinical evidences so far indicate that the two approaches both are effective in the management of hypertensive cerebral hematoma.No difference existed between the two approaches in the long term effect.Rigorously designed large sample size randomized double blind clinical trials are required to further demonstrate and support the conclusion.