微血管减压术与射频热凝术治疗三叉神经痛的疗效与安全性比较的Meta分析

Comparison of efficacy and safety between microvascular decompression and radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:a Meta analysis

目的系统评价微血管减压术(MVD)和射频热凝术(RFT)治疗三叉神经痛(TN)的疗效、安全性和经济性。方法检索1970年1月至2017年7月10日PubMed、Embase、Cochrane Library、中国知网、万方医学网、维普数据库官网关于MVD和RFT治疗TN的相关文献。严格按照纳入及排除标准对文献进行筛选,并采用纽卡斯尔-渥太华量表(the Newcastle Ottawa scale)和改良的Jadad量表进行质量评估,Revman5.3软件进行Meta分析。结果最终共纳入9个研究。Meta分析结果显示:相较于RFT,MVD有更少的患者需要二次手术[OR=0.26,95%CI(0.16~0.42),P<0.001],更少的患者出现面部麻木症状[OR=0.13,95%CI(0.08~0.21),P<0.001],更低的VAS评分[MD=-2.07,95%CI(-2.62~-1.51),P<0.001],更少的术后用药人数[OR=0.26,95%CI(0.16~0.42),P<0.001];但有更多患者出现了术后并发症[OR=2.10,95%CI(1.13~3.91),P=0.02)]和更高的治疗费用[MD=37.19,95%CI(19.90~54.47),P<0.001]。结论MVD治疗TN效果优于RFT,但并发症和治疗费用更高。因此,MVD是对TN有较好效果的治疗方式,RFT可以作为一种替代的治疗选择。

Objective To systemically evaluate the efficacy,safety and economy of microvascular decompression(MVD)and radiofrequency thermocoagulation(RFT)in the treatment of trigeminal neuralgia(TN).Methods The literatures on MVD and RFT for treatment of TN were retrieved from PubMed,Embase,Cochrane Library,CNKI,Wanfang Medical Network,and the website of Weipu database.Randomized controlled trials of MVD and RFT for primary trigeminal neuralgia were collected at home and abroad,from January 1970 to July 10,2017.The literatures were screened strictly according to the inclusion and exclusion criteria,and the Newcastle Ottawa Scale and the modified Jadad scale were used for quality assessment.Meta analysis was performed using Revman 5.3.Results A total of 9 studies were eventually included.Meta analysis results showed that,compared with RFT,fewer patients with MVD needed secondary surgery[OR=0.26,95%CI(0.16-0.42),P<0.001],fewer patients experienced facial numbness[OR=0.13,95%CI(0.08-0.21),P<0.001],lower VAS[MD=-2.07,95%CI(-2.62--1.51),P<0.001],and fewer postoperative drug users[OR=0.26,95%CI(0.16-0.42),P<0.001].However,more patients had postoperative complications[OR=2.10,95%CI(1.13-3.91),P=0.02]and more expensive treatment costs with MVD[MD=37.19,95%CI(19.90-54.47),P<0.001].Conclusion MVD is more effective in treating TN than RFT,but with more complications and higher treatment costs.RFT can be used as an alternative treatment.