国内伽玛刀与手术治疗三叉神经痛疗效的Meta分析

Efficacy and safety of gamma-knife vs. neurosurgical interventions for patients with trigeminal neuralgia in China: A Meta-analysis

目的评价伽玛刀(GKS)治疗与手术治疗三叉神经痛(TN)的疗效及安全性。方法计算机检索Pub Med、中国生物医学文献数据库、中国期刊全文数据库及万方数据库,纳入GKS治疗与手术治疗TN的随机对照试验(RCT),检索时间截止于2012年12月,由2名评价者按照纳入和排除标准独立选择文献,提取资料并评价质量。采用Stata 11.0软件进行Meta分析。结果最终纳入系统评价的1篇完全RCT文献和4篇回顾性队列研究,纳入患者564例(GKS组293例,手术组271例)。对TN疼痛缓解疗效的分析(OR=0.56,95%CI=0.06~5.64,P=0.625),两组间差异无统计学意义。治疗后面部麻木的分析(OR=0.39,95%CI=0.08~1.91,P=0.243),复发情况分析(OR=1.59,95%CI=0.68~3.73,P=0.287),两组间差异无显著性,其他并发症分析(OR=0.30,95%CI=0.15~0.62,P=0.001),两组间差异有统计学意义。结论 GKS与手术治疗TN在对疼痛的有效率、治疗后面部麻木情况、复发情况方面差异无统计学意义,但在改善治疗后其他并发症方面GKS较手术治疗TN存在显著优势。

Objective To evaluate the efficacy and safety of gamma-knife in comparison with neurosurgical interventions in the treat-ment of trigeminal neuralgia in China. Methods Randomized controlled trials （RCTs） data about gamma-knife vs. neurosurgical inter-ventions for patients with trigeminal neuralgia were collected by Pubmed,Chinese biomedical literature （CBM） database,Chinese jour-nal full-text database （CNKI） and Wanfang database,the retrieval time of RCTs ended in December 2012. Stata 14. 0 was applied for Meta-analysis. RCTs were selected,screened by two review authors according to the inclusion and exclusion criteria. The screened litera-tures were evaluated and Meta analyzed by Stata 11. 0 software. Results One complete RCT article and five retrospective cohort studies that included 564 patients （GKS group included 293 cases,neurosurgical therapy group included 271 cases） were eligible for inclusion. The Meta-analysis showed that the trigeminal neuralgia remission effect of gamma-knife therapy group was similar with neurosurgical therapy group,the difference was not statistically significant （OR = 0. 56,95% CI 0. 06-5. 64,P = 0. 625）;the facial numbness after treatment （OR = 0. 39,95% CI 0. 08-1. 91,P = 0. 243）;the other complications of gamma-knife group was significantly lower than that of neurosurgical therapy group （OR = 0. 30,95% CI 0. 15-0. 62,P = 0. 001）;the recurrence rate after treatment （OR = 1. 59,95% CI 0. 68-3. 73,P = 0. 287）. Conclusions Based on the available evidence,our results suggest that trigeminal neuralgia remission effect, facial numbness and recurrence rate of gamma-knife therapy have no significant differences. Gamma-knife radiosurgery therapy might be an effective and safe method in treating other complications for patients with trigeminal neuralgia in China.