不同治疗方案干预耐药性三叉神经痛有效性与安全性的网状Meta分析

Network Meta-analysis of efficacy and safety of different treatment regimens intervention for drug-resistant trigeminal neuralgia

目的评价不同治疗方案干预耐药性三叉神经痛(TN)的有效性与安全性。方法在线检索PubMed、The Cochrane Library、EMBase、Medine、Web of Science、中国知网、中国生物医学文献数据库、维普网和万方数据知识服务平台数据库中关于不同治疗方案干预耐药TN的随机对照试验(RCTs)。采用Review manager 5.3、Stata MP16和Network软件包对不同治疗方案干预耐药性TN的治疗后即刻有效率、治疗后1年有效率、治疗后3年有效率、并发症发生率进行贝叶斯网状Meta分析。结果共纳入28个RCTs,包括2692例患者,包含7种干预方案:微血管减压术(MVD)、半月神经节射频热凝术(RFT)、经皮穿刺微球囊压迫术(PBC)、经皮半月神经节后根甘油阻滞术(PRGR)、伽玛刀放射外科治疗(GKRS)、半月神经节脉冲射频治疗(PRF)以及RFT联合PRF(RFT+PRF)。其中28项RCTs报告了治疗后即刻有效率及并发症发生率的结果,23项RCTs报告了治疗后1年有效率的结果,16项RCTs报告了治疗后3年有效率的结果。网状Meta分析结果显示,在治疗后即刻有效率方面,RFT+PRF的累积排序概率曲线下面积(SUCRA)排名最高,其次是MVD、RFT、PBC、PRGR、PRF和GKRS。在治疗后1年有效率方面,MVD的SUCRA值排名最高,其次是RFT+PRF、RFT、PBC、GKRS、PRGR和PRF。在治疗后3年有效率方面,MVD的SUCRA值排名最高,其次是RFT+PRF、RFT、PBC、GKRS、PRGR和PRF。在并发症发生率方面,PRGR的SUCRA值排名最高,其次是MVD、PBC、RFT、RFT+PRF、GKRS和PRF。结论在上述干预耐药性TN的治疗方案中,MVD可能为治疗后1年有效率及治疗后3年有效率最高的方案;RFT+PRF可能为治疗后即刻有效率最高的方案;PRF可能为并发症发生率最低的方案。临床工作中,应考虑患者的实际情况,合理的选择治疗方案,以期让患者取得最满意的治疗效果。

Objective To evaluate the efficacy and safety of different treatment options for intervention of drugresistant Trigeminal neuralgia(TN).Methods Online search PubMed,the Cochrane Library,EMBase,Medine,Web of Science,CNKI,China Biology Medicine disc,VIP databases and Wanfang Data for RCTs of different treatment regimens for drug-resistant TN.Bayesian network meta-analysis was performed using Review Manager 5.3,Stata MP16,and network packages on the efficiency after treatment,efficiency of 1 year after treatment,efficiency of 3 years after treatment,and complication rate after treatment of different treatment options for drug-resistant TN.Results A total of 28 RCTs with 2692 patients were included,which contained 7 types of intervention options:microvascular decompression(MVD),radiofrequency thermocoagulation(RFT),percutaneous balloon compression(PBC),percutaneous retrogasserian glycerol rhizolysis(PRGR),Gamma knife radiosurgery(GKRS),pulsed radiofrequency(PRF),and RFT plus PRF(RFT+PRF).Of these,28 RCTs reported the results of the efficiency after treatment and the complication rate after treatment,23 RCTs reported the results of the efficiency of 1 year after treatment,and 16 RCTs reported the results of the efficiency of 3 years after treatment.Network meta-analysis results showed that,at postoperative efficiency,RFT+PRF showed the best surface under cumulative ranking curve(SUCRA)scores,followed by MVD,RFT,PBC,PRGR,PRF and GKRS.At the efficiency of 1 year after treatment,MVD showed the best SUCRA scores,followed by RFT+PRF,RFT,PBC,GKRS,PRGR and PRF.At the efficiency of 3 years after treatment,MVD showed the best SUCRA scores,followed by RFT+PRF,RFT,PBC,GKRS,PRGR and PRF.At the complication rate after treatment,PRGR showed the best SUCRA scores,followed by MVD,PBC,RFT,RFT+PRF,GKRS and PRF.Conclusions In the above treatment scheme of interfering with drug-resistant TN,MVD may be the most effective treatment scheme 1 year after treatment and 3 years after treatment;RFT+PRF may be the most effective scheme after treatment;PRF may be the treatment with the lowest incidence of complications.In clinical work,we should also consider the actual situation of patients and reasonably choose the treatment scheme,in order to make patients achieve the most satisfactory treatment effect.