内镜经鼻视神经管减压治疗创伤性视神经病变手术时机的Meta分析

Timing of endoscopic surgical decompression in traumatic optic neuropathy:a Meta-analysis

目的用Meta分析的方法评价内镜经鼻视神经管减压治疗创伤性视神经病变(TON)的手术时机。方法遵循证医学的原则,采用计算机检索1991年1月至2017年1月EMbase、Medline、Cochran图书馆、CNKI、万方、维普等数据库。手工检索补充,以检索有关内镜经鼻视神经管减压治疗TON的研究文献,纳入的研究,由2名评价者共同评价所纳入研究的质量。应用Rev.Man5.3软件对符合纳入标准的研究进行Meta分析及数据处理。结果共纳入13篇文献符合要求的文献研究,包括TON患者725例。Meta分析结果显示:(1)<7d手术组和>7d手术组治疗TON总有效率的OR合并值为3.65(1.83,7.31),2组差异有统计学意义(P<0.01);(2)<7d手术组和>7d手术组手术组治疗TON术前未失明组有效率的OR合并值为4.53(0.14,142.05),2组差异无统计学意义(P=0.39);(3)<7d手术组和>7d手术组治疗TON术前失明组有效率的OR合并值为2.23(1.21,4.11),两组差异有统计学意义(P=0.01)。结论内镜经鼻视神经管减压治疗TON患者<7d手术组总有效率及术前失明组有效率优于>7d手术组,术前未失明组有效率两组之间无明显差异,TON患者应尽早手术,尤其是术前失明患者。

Objective Using Meta-analysis method to evaluate endoscopic nasal optic canal decompression treatment of traumatic optic neuropathy（TON）operation time. Method Follow the principle of evidencebased medicine, computer retrieval between January 1991 and January 2017 on EMbase, Medline Cochran library, CNKI, WANFANG database, VIP and other databases. Manual retrieval as a supplement, in order to retrieve the neural endoscopic nasal optic canal decompression in the treatment TON of studies, included in the study, by two evaluators common evaluation into the quality of the research. Two researchers evaluated the quality of included studies commonly. Meta-analysis and data processing were done in the Rev. Man5.3 software. Results A total of 13 original articles were involved in the Meta-analys and including 725 patients with TON.（1） The total effective rate OR（95%CI） values is 3.65（1.83, 7.31）, the difference between two groups（less than 7 days and more than 7 days group） is significant（P〈0.01）;（2） The effective rate OR（95%CI） values is 4.53（0.14, 142.05）, the difference between two groups（preoperative not blind group of less than 7 days and more than 7 days） is not significant（P=0.39）;（3） The effective rate OR（95%CI） values is 2.23（1.21, 4.11）, the difference between two groups（preoperative blind group of less than7 days and more than 7 days） is significant（P=0.01）. Conclusion Endoscopic nasal optic canal decompression in the treatment of TON less than 7 days group total effective rate and preoperative blind group effective rate higher than more than 7 days group, preoperative not blind group effective rate has no obvious difference between two groups, patients with TON should be operation as early as possible, especially in patients with preoperative blindness.