经神经内镜和显微镜下手术治疗高血压性脑出血疗效的Meta分析

The Efficacy of Neuroendoscopic and Microscopic Surgery in the Treatment of Hypertensive Intracerebral Hemorrhage:a Meta-analysis

目的系统评价经神经内镜和显微镜下手术治疗高血压性脑出血(HICH)的疗效。方法检索2010年1月-2020年10月收录在知网、万方、维普、PubMed、EMbase等中英文数据库,根据纳入及排除标准筛选经神经内镜下和显微镜下手术治疗HICH的临床研究。采用Cochrane偏倚风险评估工具对纳入研究进行质量评价,应用RevMan 5.4软件进行Meta分析。结果共纳入14项研究,其中观察组651例,对照组752例。Meta分析结果显示:与对照组比较,观察组术后并发症发生率更低[OR=0.53,95%CI(0.33,0.85),P=0.008],术后颅内感染率更低[OR=0.48,95%CI(0.23,0.98),P=0.04],术后肺部感染率更低[OR=0.38,95%CI(0.23,0.60),P<0.0001],术后再出血率更低[OR=0.47,95%CI(0.22,0.98),P=0.04],血肿清除率更高[MD=2.32,95%CI(1.15,3.49),P=0.0001],术中出血量更低[MD=-227.45,95%CI(-281.37,-173.54),P<0.00001],手术时间更短[MD=-77.01,95%CI(-96.26,-57.77),P<0.00001],术后格拉斯哥昏迷(GCS)评分更高[MD=1.20,95%CI(0.70,1.69),P<0.00001],术后日常生活活动能力(ADL)评分更高[MD=10.17,95%CI(7.96,12.38),P<0.00001]。结论现有证据表明:经神经内镜手术较显微镜下手术治疗HICH在减少术后并发症、提高血肿清除率、促进神经系统恢复等方面更具优势,是一种安全有效的手术方式。

Objective To systematically evaluate the efficacy of neuroendoscopic and microscopic surgery for hypertensive intracerebral hemorrhage(HICH).Methods The Chinese and English databases included CNKI,WanFang,VIP,PubMed,and EMbase were searched for clinical efficacy of neuroendoscopic and microscopic surgery for HICH according to the inclusion and exclusion criteria from January 2010 to October 2020.The quality of the included literatures was assessed by the Cochrane risk of bias assessment tool,and the RevMan 5.4 software was used for Meta-analysis.Results A total of 14 literatures were included,including 651 cases in the observation group and 752 cases in the control group.The results of Meta-analysis showed that,compared with the control group,the observation group there were lower total postoperative complication rate[OR=0.53,95%CI(0.33,0.85),P=0.008],lower postoperative intracranial infection rate[OR=0.48,95%CI(0.23,0.98),P=0.04],lower postoperative pulmonary infection rate[OR=0.38,95%CI(0.23,0.60),P<0.0001],and the higher postoperative rebleeding rate[OR=0.47,95%CI(0.22,0.98),P=0.04],higher hematoma clearance rate[MD=2.32,95%CI(1.15,3.49),P=0.0001],lower intraoperative blood loss[MD=-227.45,95%CI(-281.37,-173.54),P<0.00001],shorter operation time[MD=-77.01,95%CI(-96.26,-57.77),P<0.00001],higher postoperative Glasgow Coma(GCS)score[MD=1.20,95%CI(0.70,1.69),P<0.00001]and higher postoperative Activity of Daily Living(ADL)score[MD=10.17,95%CI(7.96,12.38),P<0.00001].Conclusion The current evidence showed that compared with microscopic surgery for HICH,neuroendoscopic surgery showed more advantages in reducing postoperative complications,improving the rate of hematoma clearance,and promoting the recovery of the nervous system.Neuroendoscopic surgery was a safe and effective surgical method.