腰大池-腹腔分流术与脑室-腹腔分流术治疗交通性脑积水疗效的Meta分析

Meta-analysis of curative effects of lumboperitoneal shunts and ventriculoperitoneal shunts on communicating hydrocephalus

目的系统评价腰大池-腹腔分流术(LPS)与脑室-腹腔分流术(VPS)治疗交通性脑积水的疗效和安全性。方法计算机检索Pub Med、EMbase、Cochrane Library等外文数据库以及以及中国生物医学文献数据库、中国知网、万方数据库、维普数据库等中文数据库,收集LPS与VPS治疗脑积水的临床随机对照试验和队列研究,检索时限从2010年1月至2015年10月,文种不限。采用Rev Man5.3软件进行Meta分析。结果纳入3个随机对照试验和8个队列研究,共891例。Meta分析结果显示:LPS术后总并发症发生率、感染、分流管相关并发症和分流过度或不足发生率明显低于VPS(P<0.05),但是有效率明显低于VPS(P<0.05)。结论对于交通性脑积水,虽然LPS有效率低于VPS,但是术后并发症明显较少。两种手术方式各有利弊,建议综合病人自身状况及疾病特点,选择合适的手术方式。

Objective To analyze the clinical effects of lumboperitoneal shunt(LPS)and ventriculoperitoneal shunt(VPS)on communicating hydrocephalus and their safety.Methods The articles of randomized controlled trials and non-randomized concurrent controlled trials of communicating hydrocephalus treated by LPS and VPS published from January,2010to October,2015were searched from the data bases including PubMed,The Cochrane Library,EMbase,CNKI,CBM,VIP and WanFang Data base.According to the inclusion criteria,two reviewers independently screened articles,extracted data,and evaluated and cross-checked the quality of the included studies.Then meta-analysis was performed by RevMan5.3software.Results A total of11randomized controlled trials or non-randomized concurrent controlled trials including891participants were derived from the above-mentioned data bases.The results of meta analysis showed that the occurrence rates of the postoperative overall complications,infection,valve related complication and over-drainage/under-drainage were significantly lower in LPS group than those in VPS group(P<0.05),the effctive rate was significantly lower in LPS group than that in VPS group(P<0.05).Conclusions Current evidence suggests that LPS is superior to VPS in decreasing the occurrence rates of overall complications,infection,valve related complication and over-drainage/under-drainage rates,but LPS is inferior to VPS in overall effective rate in the patients with communicating hydrocephalus.