微创手术与开颅手术治疗外伤性颅内血肿疗效比较的Meta分析

The Minimally Invasive Surgery versus Craniotomy for Traumatic Intracranial Hemorrhage: A Meta-Analysis

目的:采用Meta分析的方法评价微创手术与开颅手术比较治疗外伤性颅内血肿的疗效。方法:计算机检索MEDLINE、EMbase、The Cochrane Library、CNKI、CBM及万方数据库中有关微创手术与开颅手术比较治疗外伤性颅内血肿的临床随机对照试验,检索时间均为自建库至2013年9月30日。由两位研究者独立筛选文献、提取资料和评价方法学质量后,采用RevMan5.1软件进行Meta分析。结果:共纳入10个随机对照试验共925例患者。Meta分析结果显示相比开颅组:微创手术总有效率提高2.64倍[OR=2.64,95%CI=(1.72~4.05)],手术时间缩短1.5 h[MD=-1.50,95%CI=(-2.09^-0.91)]、并发症发生率降低99.3%[OR=0.07,95%CI=(0.04~0.12)]、昏迷患者术后清醒时间缩短2.45 d[MD=-2.45,95%CI=(-2.99^-1.90)]、术后住院时间缩短9.99d[MD=-9.99,95%CI=(-14.11^-5.87)]、降低住院费用1.26万元[MD=-1.26,95%CI=(-2.95~0.43)]。结论:现有证据显示,在清除外伤性颅内血肿方面,微创手术显著优于开颅手术。

Objective To assess the clinical efficacy of minimally invasive surgery versus craniotomy for traumatic intracranial hemorrhage using a meta-analysis. Methods The MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, and Wanfang da- tabases were searched up to September 30, ：2013 to comprehensively collect the randomized clinical controlled trials （RCTs）. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and as- sessed the methodological quality. Then the meta-analysis was performed using RevMan5. I software. Results A total of 10 RCTs involving 925 patients were included. Compared with craniotomy, the results of meta-analysis showed that the minimal- ly invasive surgery group was significantly increased the total effective rate 2.64 times[ OR = 2.64,95% CI = （ 1.72 ~ 4.05 ） ], decreased the time of operation 1.5 hours [ MD = - 1.50,95% CI = （ - 2.09 ~ - 0.91 ） ], decreased the operative complication occurrence rate 99.3% [ OR = 0.07, 95% CI = （ 0.04 - 0.12 ） ~, reduce the recovery time from coma 2.45 days [ MD = - 2.45,95% CI = （ - 2.99 - - 1.90） ], shorten the length of stay after surgery 9.99 days [ MD = - 9.99, 95% CI = （ - 14. t 1 ~ - 5.87 ） ], and diminish the total costs 1.26 million RMB [ MD = - 1.26,95% CI = （ - 2.95 ~ 0. 43） 1. Conclusion Current evidence has proved that the minimally invasive surgery is better than the craniotomy in the treatment of traumatic intracranial hemorrhage.