3D Slicer软件辅助神经内镜手术治疗脑出血的系统评价

Systematic evaluation of 3D Slicer software-assisted endoscopic neurosurgery in the treatment of cerebral hemorrhage

目的 系统评价3D Slicer软件在神经内镜手术治疗脑出血中的应用价值。方法 截止至2018年10月,检索CBM、WangFang、CNKI、PubMed、Embase、Cochrane Central Register of Controlled Trials数据库,查找3D Slicer软件辅助神经内镜手术治疗脑出血的临床试验,包括随机试验(randomised controlled trials,RCTs)及非随机对照试验(non-randomised controlled trials,Non-RCTs),两位研究者根据纳入标准进行文献筛选以及数据提取。结果纳入1个随机对照研究及5个非随机对照研究,共348例患者。结果 提示在3D Slicer软件辅助下,神经内镜组血肿清除率较高[MD=12.42,95%CI(6.85,18.00),P<0.0001]、预后较好[SMD=-0.58,95%CI(-0.82,-0.34),P<0.00001],而神经内镜组手术时间[SMD=-2.94,95%CI(-4.06,-1.81),P<0.0001]、手术失血量[SMD=-7.51,95%CI(-11.18,-3.85),P<0.0001]、术后并发症[OR=0.26,95%CI(0.12,0.56),P<0.001]均显著降低。结论 3D Slicer软件辅助神经内镜手术治疗脑出血是安全、有效、可行的,在3D Slicer软件的辅助下,神经内镜可以完整清除血肿,节省手术时间,减少术中出血量,降低术后并发症发生率,从而改善患者的预后。

Objective To systematically evaluate the application value of 3D Slicer software combined with endoscopic neurosurgery in the treatment of cerebral hemorrhage.Methods By October 2018,the databases of CBM,WangFang,CNKI,PubMed,Embase and Cochrane Central Register of Controlled Trials were searched to find clinical trials of 3D Slicer software-assisted endoscopic neurosurgery for cerebral hemorrhage,including randomised controlled trials(RCTs)and non-randomized controlled trials(Non-RCTs).The two researchers performed literature screening and data extraction according to inclusion criteria.Results One RCT and five Non-RCTs were included and a total of 348 patients were enrolled in this review.The results indicated that with the help of 3D Slicer software,the endoscopic neurosurgery group had higher hematoma clearance rate[MD=12.42,95%CI(6.85,18.00),P<0.0001],and better prognosis[SMD=-0.58,95%CI(-0.82,-0.34),P<0.00001],and the operative time[SMD=-2.94,95%CI(-4.06,-1.81),P<0.0001],the amount of blood loss[SMD=-7.51,95%CI(-11.18,-3.85),P<0.0001]and postoperative complications[OR=0.26,95%CI(0.12,0.56),P<0.001]were significantly reduced in the endoscopic neurosurgery group.Conclusion 3D Slicer software-assisted endoscopic neurosurgery for cerebral hemorrhage is safe,effective and feasible.With the assistance of 3D Slicer software,endoscopic neurosurgery can completely remove hematoma,save operation time,reduce intraoperative bleeding and reduce the incidence of postoperative complications,so as to improve the prognosis of patients.