神经内镜术与小骨窗血肿清除术治疗高血压脑出血疗效的Meta分析

Clinical efficacy of neuroendoscopy versus small bone window hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage: A metal-analysis

目的对比神经内镜术和小骨窗血肿清除术治疗高血压脑出血的临床疗效.方法检索2008年-2018年的万方、维普和PubMed等中英文数据库,找出对比神经内镜术和小骨窗血肿清除术治疗高血压脑出血的文献,利用RevMan 5.3软件进行Meta分析.结果共纳入4篇随机对照研究和6篇病例对照研究,965例中神经内镜组493例,小骨窗组472例.Meta分析结果示:与小骨窗组相比,内镜组血肿清除率更高(SMD=14.20;95%CI=[8.48,19.92]),术中出血量更少(SMD=-215.06,95%CI=[-255.41,-174.71]),手术时间更短(SMD=-96.63,95%CI=[-114.24,-79.01]),ICU入住时间缩短(OR=-5.91,95%CI=[-6.26,-5.57]),术后并发症更少(OR=0.28,95%CI=[0.19,0.43]),术后6个月恢复良好率更佳(OR=2.02,95%CI=[1.54,2.66]),病死率更低(OR=0.32,95%CI=[0.16,0.62]).所比较结果均具有统计学意义.结论与小骨窗术相比,神经内镜术治疗高血压脑出血其预后更佳、病死率更低,疗效更好,并且清除率更高,术中出血量减少,手术时间变短,ICU入住天数减少,术后并发症较少,故值得推广.

Objective To compare the clinical efficacy of neuroendoscopy and small bone window hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage.Methods Studies comparing the efficacy of neuroendoscopy and small bone window hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage between 2008 to 2018 were selected from Wanfang Data,VIP,and PubMed.A meta-analysis was performed using the RevMan 5.3 software.Results A total of 4 randomized controlled studies and 6 case-control studies were included.Of the 965 cases,493 were in the neuroendoscopy group and 472 were in the small bone window group.The meta-analysis of these studies showed that the neuroendoscopy group had a significantly higher hematoma evacuation rate(standardized mean difference[SMD]=14.20,95%confidence interval[CI]:8.48-19.92),significantly less intraoperative bleeding(SMD=-215.06,95%CI:-255.41 to-174.71),a significantly shorter operation time(SMD=-96.63,95%CI:-114.24 to-79.01),significantly shorter ICU stay(odds ratio[OR]=-5.91,95%CI:-6.26 to-5.57),and fewer postoperative complications(OR=0.28,95%CI:0.19-0.43)than the small bone window group(all P<0.05).Furthermore,compared with the small bone window group,the neuroendoscopy group had a significantly higher good recovery rate at 6 months post-surgery(OR=2.02,95%CI:1.54-2.66)and a significantly lower mortality rate(OR=0.32,95%C/:0.16-0.62)(both P<0.05).Conclusions Neuroendoscopy has better prognosis,lower mortality,and superior efficacy than small bone window hematoma evacua tion in the treatment of hypertensive intracerebral hemorrhage.Furthermore,neuroendoscopy results in higher hematoma evacuation rate,less intraoperative blood loss,shorter operation time,shorter ICU stay,and fewer postoperative complications,and therefore holds promise for clinical application.