显微镜下和神经内镜下行显微血管减压术的Meta分析

Microscopic and neuroendoscopy assisted microvascular decompression： a Meta-analysis

目的比较显微镜和神经内镜下行显微血管减压术的临床疗效。方法通过检索PubMed、CochraneLibrary、Embase、维普网、CNKI以及万方数据库，查找神经内镜和显微镜下行显微血管减压术治疗三叉神经痛或面肌痉挛的对照试验，检索时限为建库至2017年4月1日。对所检出的文献进行筛选及资料提取后，以RevMan5．3软件进行Meta分析。结果最终纳入符合入选标准的10篇文献，研究对象共计1010例患者。Meta分析结果显示：（1）安全性方面：与显微镜相比，内镜组的术后并发症更少，差异有统计学意义（RR=0．650，95％CI：0．530～0．800，P=-0．000）；术后面瘫发生率更低，差异有统计学意义（RR=0．580，95％CI：0．360～0．930，P=0．020）。手术时间、术后脑脊液漏、听力障碍、颅内感染等方面2组的差异均无统计学意义（P〉0．05）。f2）疗效性方面：与显微镜相比，内镜下行显微血管减压术预后更佳，差异有统计学意义（RR=1．110，95％CI：1．060～1．160，P=0．0001；复发率更低，差异有统计学意义（RR=0．100，95％CI：0．020-0．530，P=0．007）。结论与显微手术相比，神经内镜下行显微血管减压术疗效更好、复发率更低，且安全性更高。

Objective To compare the clinical efficacies of endoscopy-assisted microvascular decompression and microscopic microvascular decompression. Methods PubMed, Cochrane Library, Embase, VIP, CNKI and Wanfang database were retrieved. The randomized controlled trials comparing trigeminal neuralgia and hemifacial spasm treated with endoscopy-assisted microvascular decompression and microscopic microvascular decompression were chosen. The retrieval time was fIom the establishment of the database to April 1^st, 2017. After the detected literatures being screened, extracted and evaluated, a Meta-analysis was performed using RevMan 5.3 software. Results Finally, a total of 10 trials with 1010 patients were enrolled. The results of Meta-analysis showed： （1） in the aspect of effectiveness, patients f^om the neuroendoscope group had significantly better prognosis （RR=l.110, 95%CI： 1.060-1.160, P=0.000） and statistically lower relapse rate （RR=0.100, 95%CI： 0.020-0.530, P=0.007） as compared with the microsurgery group; （2） in the aspect of safety, patients t^om the neuroendoscope group had fewer postoperative complications （RR=0.650, 95%CI： 0.530-0.800, P=- 0.000） and lower postoperative paralysis incidence rate （RR=0.580, 95%CI： 0.360-0.930, P=0.020） as compared with the microscope group. There were no significant differences in the operation time, incidence of cerebrospinal fluid leakage, hearing loss or intracranial infections between the 2 groups （/9〉0.05）. Conclusion As compared with those in patients accepted microscopic microvascular decompression, the prognosis of patients accepted endoscopy-assisted microvascular decompression is better, the relapse rate is lower, and safety is higher.