两种术式治疗Chiari畸形Ⅰ型临床疗效比较的Meta分析

Efficacy comparison of the two surgical methods in the treatment of Chiari Ⅰmalformation: a meta-analysis

目的系统评价颅后窝减压加硬脑膜成形术(对照组)与颅后窝减压加硬脑膜成形术加小脑扁桃体切除术(试验组)两种术式在治疗Chiari畸形Ⅰ型的临床疗效。方法通过计算机检索Pubmed、Cochrance、Spring Link、Science Direct、万方数据库、中国知网、维普中文数据库,按照纳入与排除标准选择文献,提取资料,使用NOS量表对纳入研究进行质量评价,采用Stata14.0软件对数据进行Meta分析。结果共纳入11篇回顾性队列研究、818例病人。Meta分析结果显示:与对照组相比,试验组的术后临床症状改善明显(P=0.002),而术后头痛(P=0.045)、脑脊液漏(P=0.014)的发生率明显升高;两组在脊髓空洞改善(P=0.906)、远期症状改善(P=0.113)、术后颅内感染(P=0.101)、术后切口感染(P=0.654)方面差异均无统计学意义。结论试验组术后可明显改善症状,但并发症较多,同时在远期症状和脊髓空洞改善与对照组无差异,在治疗Chiari畸形Ⅰ型不推荐颅后窝减压加硬膜成形术加小脑扁桃体切除术。

Objective To systematically evaluate the clinical efficacy of posterior fossa decompression with duraplasty(control group) and posterior fossa decompression with duraplasty and cerebellar tonsil resection(experimental group) in the treatment of Chiari Ⅰ malformation. Methods The literatures were selected according to the inclusion and exclusion criteria from the databases of Pubmed,Cochrance, Spring Link, Science Direct, CNKI, Wanfang and VIPC. Then, the data were extracted and the qualities of included studies were evaluated by the Newcastle-Ottawa Scale. Finally, Meta analysis was performed by Stata14.0 software. Results Eleven studies involving 818 patients were included. The results of Meta analysis showed that the clinical symptoms significantly improved(P=0.002),while the incidence rate of postoperative headache(P=0.045) and cerebrospinal fluid leakage(P=0.014) significantly rose in the experimental group. Otherwise, there was no significant difference in the improvement of syringomyelia sign(P=0.906), long-term symptoms(P=0.113) and the incidence rate of postoperative intracranial infection(P=0.101) and incision infection(P=0.654) between the control and experimental group. Conclusions The clinical symptoms significantly improve in the experimental group, but with more complications, and there is no difference in the improvement of long-term symptoms and syringomyelia. Therefore, posterior fossa decompression with duraplasty and cerebellar tonsillectomy is not recommended for the treatment of Chiari Ⅰ malformation.