手术治疗儿童无症状脂肪瘤型脊髓拴系的Meta分析

The meta-analysis of surgical treatment of pediatric asymptomatic lipomas in the spinal cord

目的评价预防性手术治疗儿童无症状脂肪瘤型脊髓拴系的风险和意义。方法在PubMed、Embase、Scopus、Web of Science、Cochrane databases数据库中检索手术治疗和单纯随访的儿童无症状脂肪瘤型脊髓拴系的相关研究，采用RevMan5．3和R软件对数据进行合并分析。结果共纳入5篇非随机临床对照试验的文献，合计403例患者，总随访时间为4．4～10．0年。其中单纯随访组124例，发生神经功能障碍者32例（25．8％）；手术组279例，发生神经功能障碍者30例（10．8％），差异有统计学意义（P=0．05）。同时检索到9篇单纯手术的文献（278例）和1篇观察自然史的文献（56例）。合并统计单纯手术的9篇文献，采用随机效应模型计算术后神经功能障碍的发生率为10．0％，与随访组的28．6％（16／56）比较，差异有统计学意义（P〈0．01）。结论对于儿童无症状脂肪瘤型脊髓拴系，目前有限的文献资料支持预防性手术可以使患儿获益，今后尚需要更大样本的循证医学证据。

Objective To explore the risk and significance of prophylactic surgery in the treatment of asymptomatic pediatric spinal cord lipomas. Methods We collected and reviewed studies of asymptomatic spinal cord lipomas in children from databases including PnbMed, Embase, Scopus, Web of Science and Cochrane databases. RevManS. 3 and R software were used to conduct comparison between cases undergoing prophylactic surgery and those who were followed up without operations. Results Five non-randomized controlled studies were reviewed and reported a total of 403 patients followed up for 4.4 - 10. 0 years, among whom 124 patients received merely follow-up including 32 （25.8%） cases demonstrating neurological deterioration. The otber 279 patients received prophylactic surgical treatment and 30 （ 10.8% ） reported neurological dysfunction. The difference was statistically significant （P = 0.05）. At the same time, 9 literatures of merely surgery （278 cases） and 1 report （56 cases） of natural history were combined. The rate of neurological dysfunction was 10.0% post operation, which was significantly different from 28.6% （16/56） in the group with only follow-up based on the random effect model （ P 〈 0.01 ）. Conclusion For asymptomatic spinal cord lipomas in children, limited literatures have suggested that prophylactic surgery might be beneficial to prevention of neurological deterioration, which needs evidences with large sample sizes in future research.