骨膜下引流与硬膜下引流治疗慢性硬膜下血肿临床效果的Meta分析

Meta-analysis of clinical effects of subperiosteal drainage and subdural drainage in the treatment of chronic subdural hematoma

目的系统性对比慢性硬膜下血肿(CSDH)患者钻孔引流术中选择骨膜下引流(SPD)与硬膜下引流(SDD)的临床疗效。方法系统检索PubMed、Embase、Cochrane Library、ClinicalTrials.gov、中国知网、万方、维普以及中国生物医学文献数据库中关于SPD与SDD治疗CSDH的相关文献, 检索文献的发表日期截至2021年3月。SPD组与SDD组提取的主要结局指标为血肿复发, 次要结局指标为脑实质损伤、颅内感染、死亡以及术后癫痫。采用CochranQ检验和I2值评估研究异质性, 异质性程度较高采用随机效应模型合并效应值, 否则采用固定效应模型合并效应值。采用漏斗图和Egger检验评估研究是否存在发表偏倚。结果最终纳入10篇文献(共3 345例次手术, SPD组为1 602例次, SDD组为1 743例次), 其中随机对照和非随机对照研究各2篇, 队列研究6篇。Meta分析结果显示, SPD组与SDD组比较, 血肿复发率(RR=0.90, 95%CI:0.65~1.26, P=0.55)、颅内感染率(RR=0.88, 95%CI:0.47~1.65, P=0.70)、病死率(RR=0.85, 95%CI:0.71~1.03, P=0.10)以及术后癫痫发生率(RR=0.91, 95%CI:0.52~1.58, P=0.73)的差异均无统计学意义;而SPD组脑实质损伤的发生率较SDD组降低(RR=0.14, 95%CI:0.05~0.40, P<0.01)。结论 CSDH钻孔引流术中选择SPD较SDD的脑实质损伤风险更低, 而血肿复发率、病死率相似。

Objective To systematically compare the efficacy of subperiosteal drainage(SPD)and subdural drainage(SDD)in patients with chronic subdural hematoma(CSDH)during burr hole drainage.Methods PubMed,Embase,Cochrane Library,ClinicalTrials.gov,CNKI,Wanfang,VIP and China Biomedical Literature Database were systematically searched for relevant literatures on SPD and SDD in the treatment of CSDH.The publication date of the searched literature was until March 2021.The primary outcome measure extracted from the SPD group and SDD group was hematoma recurrence,and the secondary outcome measures were brain parenchyma injury,intracranial infection,death,and postoperative epilepsy.Cochran Q test and I2 value were used to evaluate the study heterogeneity.If the degree of heterogeneity was high,the random effect model was used to combine the effect values.Otherwise,the fixed effect model was used to combine the effect values.A funnel plot and Egger′s test were used to assess whether the study was subject to publication bias.Results Finally,10 articles were included(3345 cases in total,1602 cases in SPD group and 1743 cases in SDD group),which included 2 randomized controlled,2 non-randomized controlled studies and 6 cohort studies.Meta-analysis results showed that there were no significant differences in the recurrence rate of hematoma(RR=0.90,95%CI:0.65-1.26,P=0.55),the incidence of intracranial infection(RR=0.88,95%CI:0.47-1.65,P=0.70),mortality(RR=0.85,95%CI:0.71-1.03,P=0.10),or postoperative epilepsy incidence(RR=0.91,95%CI:0.52-1.58,P=0.73)between the SPD and SDD groups.However,the incidence of brain parenchyma injury in the SPD group was lower than that in the SDD group(RR=0.14,95%CI:0.05-0.40,P<0.01).Conclusion Compared with SDD,the risk of brain parenchymal injury seems to be lower when SPD is selected in CSDH during burr hole drainage.