手术和伽马刀治疗较小听神经瘤的Meta分析

A Meta-Analysis of Surgery and Gamma-Knife Treatment for Acoustic Neuroma Less than Three Centimeters in Diameter

目的比较手术及伽马刀治疗<3cm听神经瘤的优劣。方法由2名研究人员分别检索1990年1月1日—2010年3月31日四川大学网上图书馆CENTRAL、ISI、Medline、Embase、NLM Gateway、CBMdisc等数据库的相关论文,选择证据级别最高的文献,使用Cochrane图书馆提供的RevMan 5.0软件,对手术和伽马刀治疗小型听神经瘤在面神经、听力功能保留的优劣方面进行Meta分析。结果共检索到4篇前瞻性队列研究,排除2篇。剩余的2篇文献共纳入患者173例,分析发现,在1年随访及随访结束时,手术治疗组与伽马刀治疗组相比,在面神经功能完整保留方面,RR值及其95%CI分别为0.64(0.53,0.77)、0.67(0.47,0.96);在保留有用听力方面,RR值及其95%CI分别为0.08(0.02,0.27)及0.08(0.02,0.28)。结论伽马刀治疗<3cm的听神经瘤,无论在保留有用听力还是面神经功能方面均明显优于手术。

Objective To compare surgery and gamma-knife treatment in treating acoustic neuroma less than 3 cm in diameter through Meta analysis.Methods Two researchers respectively searched relevant papers from such databases as CENTRAL,ISI,Medline,Embase,NLM Gateway,and CBMdisc posted on the online library of Sichuan University.Papers with the highest-grade evidence were selected,and RevMan 5.0 provided by Cochrane Library was used to compare surgery and gamma-knife treatment in the preservation of patients＇ facial nerves and useful hearing through Meta analysis.Results Four prospective cohort studies were found,two of which were excluded.The remaining two articles were analyzed,and we compared surgery and gamma-knife treatment during the 1-year and the last follow-up period in facial nerve preservation and useful hearing preservation.The RR value and 95% CI of the comparison was respectively 0.64（0.53,0.77） and 0.67（0.47,0.96） for facial nerve preservation,and 0.08（0.02,0.27） and 0.08（0.02,0.28） for useful hearing preservation.Conclusion Gamma-knife treatment for acoustic neuroma less than 3 cm in diameter is a much better choice than surgery in preserving hearing and facial nerve function.