视神经管减压术治疗外伤性视神经病变有效性及安全性Meta分析

Meta-analysis of effect of endoscopic transnasal optic canal decompression on traumatic optic neuropathy and its safety

目的系统评价神经内镜辅助视神经管减压术治疗外伤性视神经病变(TON)的临床疗效及安全性。方法计算机检索PubMed、EMBASE、Cochrane临床试验数据库、中国生物医学文献数据库(CBM)、维普数据库(VIP)、中国期刊网全文数据库(CNKI)、万方数据库等,纳入所有关于神经内镜辅助视神经管减压术治疗TON患者的随机对照研究及临床对照研究。使用Cochrane系统评价员手册(版本5.0.1)评定所有纳入研究的质量,并用RevMan 5.1软件对收集的数据进行Meta分析。结果最终纳入12个符合标准的研究,共1 176例患者。Meta分析结果显示:①对于提高患者的视力恢复程度,神经内镜组明显优于激素治疗组(OR=1.83;95%可信区间:1.09～3.06;P<0.05);②对于提高患者视力恢复程度,神经内镜组与经颅视神经管减压术组比较,差异无统计学差异(OR=0.71;95%可信区间:0.47～1.06;P>0.05)。结论神经内镜辅助经鼻视神经管减压术治疗TON的临床疗效优于传统激素治疗。虽然神经内镜组与开颅手术视神经管减压术组比较,对视力恢复的有效率无统计学差异,但其具有创伤更小、恢复更快、手术时间更短、并发症更少等优点。

Objective To evaluate the clinical effect of endoscopic transnasal optic canal decompression （ETOCD） on traumatic optic neuropathy （TON） and its safety. Methods The databases of Pubmed （1966 to April 2012）, Embase （1974 to April 2012）, the Coehrane clinical trials database （2012）, Chinese Biomedical Literature Database （CBM, 1978 to 2012 April）, Weipu database （VIP, 1989 to 2012 April）, China Journal Full-text Database （CNKI, 1994 to 2012 April）, Wanfang Database （1997 to April 2012） were searched for randomized controlled trials （RCTs） or controlled clinical trials （CT） comparing ETCOD treatment with steroids or traditional optic canal decompression （TOCD） treatment of TON. Cochrane Systematic Review Handbook （version, 5.0.0） was used to assess the quality of studies and the RevMan 5.1 software was used to analyze the data. Results We screened 12 eligible studies including 1 176 patients with TON. The visual power level was significantly improved in the patients treated with ETOCD compared with those treated with steroids [odds ratio （OR）： 1.83; 95% confidence interval （CI）： 1.09-3.06; P〈0.05]. There were no significant difference in the improvement of postoperative visual power between the patients treated with ETOCD and ones treated with TOCD （OR： 0.71; 95% Ch 0.47-1.06; P〉0.05）. Conclusions The curative effect of ETOCD on TON is better than that of steroids. Although ETOCD is similar to TOCD in the curative effects on TON, ETOCD is of the advantages including less operative side-injury, patient＇s rapid recovery, shorter operation time and less complication compared to TOCD.