射频热凝术与球囊压迫术治疗三叉神经痛的疗效与安全性比较:Meta分析

Comparison of efficacy and safety of radiofrequency thermocoagulation and balloon compression for treatment of trigeminal neuralgia:a Meta-analysis

目的系统评价射频热凝术(RFT)与球囊压迫术(PBC)治疗原发性三叉神经痛(TN)的疗效及安全性。方法计算机检索PubMed、Embase、Cochrane Library、CNKI、万方、维普等数据库从建库至2023年1月1日之间关于RFT与PBC治疗原发性TN的文献。由两名研究者严格按照纳入及排除标准进行文献收集、质量评价、数据提取,并交叉核对,然后采用Reman 5.4软件进行Meta分析。结果最终纳入13项研究。Meta分析结果显示:在术后3个月时的优效率及有效率方面,PBC均优于RFT[OR=0.43,95%CI(0.22,0.82),P=0.01;OR=0.42,95%CI(0.18,0.97),P=0.04],且此时的疼痛评分也低于RFT[MD=0.72,95%CI(0.27,1.18),P=0.002]。在术后2年,PBC的疼痛评分低于RFT[MD=1.21,95%CI(0.06,2.35),P=0.04],但两者在长期有效率及复发率上差异并无统计学意义(P均>0.05)。在术后并发症方面,RFT有着更低的面部麻木、咀嚼肌肌力下降及口唇疱疹的发生率[OR=0.50,95%CI(0.28,0.90),P=0.02;OR=0.33,95%CI(0.20,0.57),P<0.001;OR=0.29,95%CI(0.12,0.69),P=0.005]。对于既往有手术史的复发TN患者,PBC有着更好的疗效[OR=0.26,95%CI(0.15,0.42),P<0.001]。结论PBC与RFT均是有效治疗TN的方法。对于初次行手术治疗的原发性TN的患者,两种方法有效率相当,但RFT术后并发症发生率更低;对于既往有手术病史的复发TN患者,PBC则是更好的选择。

Objective To systematically evaluate the efficacy and safety of radiofrequency thermocoagulation(RFT)and percutaneous balloon compression(PBC)in the treatment of primary trigeminal neuralgia(TN).Methods Computer retrieved PubMed,Embase,Cochrane Library,CNKI,Wanfang Medical Network,and the website of Weipu databases from the establishment of the database to January 1,2023 on the treatment of primary TN treated with RFT and PBC.Two researchers conducted literature collection,quality evaluation,data extraction and cross-check in strict accordance with the inclusion and exclusion criteria,and then used Reman 5.4 software for Meta-analysis.Results Thirteen studies were finally included.The results of Meta-analysis showed that PBC was superior to RFT in terms of apparent and effective rate at 3 months after the operation[OR=0.43,95%CI(0.22,0.82),P=0.01;OR=0.42,95%CI(0.18,0.97),P=0.04],and the pain score was also lower than RFT at this time[MD=0.72,95%CI(0.27,1.18),P=0.002].Two years after the operation,the pain score of PBC was lower than that of RFT[MD=1.21,95%CI(0.06,2.35),P=0.04],but there was no significant difference in the long-term effective rate and recurrence rate between the two groups(all P>0.05).RFT has a lower incidence of facial numbness,decreased masticatory muscle strength and lip herpes[OR=0.50,95%CI(0.28,0.90),P=0.02;OR=0.33,95%CI(0.20,0.57),P<0.001;OR=0.29,95%CI(0.12,0.69),P=0.005].PBC has a better effect on patients with history of surgery and recurrent TN[OR=0.26,95%CI(0.15,0.42),P<0.001].Conclusion Both PBC and RFT are effective methods to treatment of TN.For patients with primary TN,the two methods have the same effective rate,but the incidence of complications after RFT is lower.For patients with history of surgery and recurrent TN,PBC is a better choice.