内镜在显微血管减压术中安全性和有效性的系统回顾

A systematic review on safety and effectiveness of endoscope in microvascular decompression

目的了解内镜在显微血管减压术中应用的有效性和安全性。方法系统检索2002年至2014年在显微血管减压术治疗三叉神经痛和面肌痉挛中应用了内镜的中英文文献。根据预先设定的纳入标准筛选文献后采集文献中相关数据,包括：论文作者、通信作者单位、发表时间、病例总数、术后三叉神经痛或面肌痉挛完全消失的病例数、并发症（感染,面部麻木,面瘫,耳鸣,听力下降,脑脊液漏及死亡）发生病例数以及随访时间。统计总的手术完全有效率和并发症发生率。结果在三叉神经痛和面肌痉挛的的研究中,手术完全有效率分别为93%（95%CI：90~96）和94%（95%CI：91~96）。各项并发症的发生率为1%~8%。结论内镜应用于显微血管减压治疗三叉神经痛和面肌痉挛,具有较高的有效性和安全性,但需要较高级别的循证医学证据（随机对照试验）来证实。

Object To investigate the effectiveness and safety of endoscope in microvascular decompression（MVD）.Method A comprehensive literature review of articles in both English and Chinese that described the application of endoscopy in MVD for trigeminal neuralgia （ TN ） or hemifacial spasm from 2002 to 2014 . The articles were screened according to predetermined inclusion criteria and data including authors , institution of corresponding author , year of publishing , number of patient population , number of patients without symptoms after surgery , number of patients suffered complications （ infection, hemifacial numbness, hemifacial palsy, tinninus, change of hearing , cerebral spinal fluid leakage and death ） and duration of follow-up were extracted .The pooled rates of success and complication were calculated .Results The pooled success rates in trigeminal neuralgia and hemifacial spasm study were 93%（95%CI：90-96） and 94%（95%CI：91-96 ） respectively , with each compliation rate ranging from 1% to 8%.Conclusion Although endoscopic vascluar decompression for TN and hemifacial spasm is effective and safe , it still needs to be confirmed by studies （ random controled trail ） with high-grade evidence .