脑室-腹腔分流术同期颅骨修补治疗颅骨缺损合并脑积水的Meta分析

Concurrent operation of ventriculoperitoneal shunt and cranioplasty for the treatment of cranial defect and hydrocephalus:A meta-analysis

目的系统评价脑室-腹腔分流术(ventriculoperitoneal shunt,VPS)和颅骨修补术同期与分期手术治疗颅骨缺损合并脑积水后的并发症情况。方法检索Pubmed、EMbanse、The Cochrane Library、中国知网、万方数据库,搜集2008年1月-2019年12月同期手术(同期组)及分期手术(分期组)治疗颅骨缺损合并脑积水的随机对照试验(randomized controlled trial,RCT)和病例对照研究,采用RevMan5.3统计软件对术后感染等并发症资料进行Meta分析。结果共纳入17篇高质量文献。Meta分析结果显示:与分期组比较,同期组术后分流管故障、过度分流发生率更低(P<0.05);而两组术后分流不足、颅内出血发生率差异无统计学意义(P>0.05)。同期组与分期组术后颅内感染发生率无明显差异(P>0.05),但按原发病因进行分组分析显示:脑外伤组内,同期组比分期组的颅内感染发生率更低(P<0.05),而其他病因组内两者无明显差异(P>0.05)。结论对颅骨缺损合并脑积水病人,同期手术具有更低的感染、分流管故障、过度分流发生率,在临床运用中可能更具优势。

Objective To systematically assess the complications of concurrent operation and staging operation of ventriculoperitoneal shunt(VPS)and cranioplasty for the treatment of cranial defects and hydrocephalus.Methods The randomized controlled trial(RCT)and case-control studies of concurrent operation(concurrent group)and staging operation(staging group)for the treatment of cranial defects and hydrocephalus were collected from January 2008 to December 2019 in Pubmed,Embase,the Cochrane Library,CNKI and Wanfang databases.Meta analysis was used to assess the data on postoperative infection and other complications data by RevMan5.3 software.Results Seventeen high quality studies were selected finally.The meta analysis showed,compared with the staging group,concurrent group had lower shunt failure rate and excessive shunt rate(P<0.05),while there was no statistically significant difference in the rate of insufficient shunt,intracranial hemorrhage and infection between the two groups(P>0.05).However,grouping analysis according to the primary cause showed in the traumatic brain injury group,the intracranial infection rate was lower in the concurrent group than in the staging group(P<0.05);while in the other etiology group,there was no significant difference between the concurrent group and staging group(P>0.05).Conclusion Concurrent operation has lower incidence rates of infection,shunt failure and excessive shunt for the patients with cranial defects and hydrocephalus,and may have more advantages in clinical application.