术中超声对脑胶质瘤手术效果影响的Meta分析

The influence of intraoperative ultrasound on surgical outcomes of patients with gliomas: a meta-analysis

目的系统性评价术中超声对脑胶质瘤患者手术效果的影响。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、维普和万方数据库中发表于2013年1月1日至2023年12月31日关于术中超声对脑胶质瘤患者影响的队列研究。由2名研究者独立筛选文献、提取资料并评价纳入研究的质量后,使用RevMan 5.4软件和Stata 16.0软件进行Meta分析。主要结局指标为手术全切除率,次要结局指标为手术时长和术后Karnofsky功能状态评分。采用χ^(2)检验和I2值评估研究的异质性,P<0.05或I2>50%时采用随机效应模型分析,否则采用固定效应模型合并效应值。结果共纳入17项队列研究,共计1364例脑胶质瘤患者。Meta分析结果显示:术中超声组(730例)与常规手术组(634例)比较,肿瘤全切除率更高[相对危险度(RR)=1.52,95%CI:1.38~1.66,P<0.001]、手术时长更短[标准化均数差(SMD)=-0.60,95%CI:-0.96~-0.23,P=0.001]、术后Karnofsky功能状态评分更高(SMD=0.76,95%CI:0.43~1.09,P<0.001)。结论使用术中超声可提高脑胶质瘤患者的手术效果并缩短手术时长。

Objective To systematically review the influence of intraoperative ultrasound on surgical outcomes of patients with gliomas.Methods PubMed,Embase,Cochrane Library,CNKI,VIP and WanFang databases were electronically searched to identify cohort studies investigating the influence of intraoperative ultrasound on surgical outcomes of patients with gliomas,which were published between January 1,2013 and December 31,2023.Two reviewers independently screened literatures,extracted data and assessed the risk of bias of included studies.Then meta-analysis was conducted using RevMan 5.4 software and Stata 16.0 software.The primary outcome measure was gross total resection(GTR)rate,and the secondary outcome measures were surgical duration and postoperative Karnofsky performance status score.Theχ^(2) test and I2 value were used to evaluate the heterogeneity between the results of included studies.In case of P<0.05 or I2>50%,the random effect model would be used to calculate the effect size.Otherwise,the fixed effect model would be used to calculate the effect size.Results A total of 17 cohort studies were included in the analysis,incorporating 1364 glioma patients.The results of meta-analysis showed that compared with the conventional surgery group(634 cases),the intraoperative ultrasound group(730 cases)had a higher GTR rate(RR=1.52,95%CI:1.38-1.66,P<0.001),a shorter surgical duration(SMD=-0.60,95%CI:-0.96--0.23,P=0.001),and a higher postoperative Karnofsky performance status score(SMD=0.76,95%CI:0.43-1.09,P<0.001).Conclusion The use of intraoperative ultrasound can improve surgical outcomes and shorten surgical duration of patients with gliomas.