微创穿刺术对比传统钻孔引流术治疗慢性硬膜下血肿疗效分析——meta分析

Efficacy comparison of minimally invasive puncture and traditional trepanation and drainage in treatment of chronic subdural hematoma: a meta-analysis

摘要:

目的 比较微创穿刺引流术与传统钻孔引流术治疗慢性硬膜下血肿疗效及预后。方法 按照文献纳入及排除标准,严格进行文献质量评价,利用ReMan 5.0软件对纳入的临床随机对照研究采用meta分析进行分析比较。结果 纳入11个临床研究,共909名患者。两者手术方式在手术时间(MD=-28.31 95%CI[-29.53,-27.09],P<0.00001),术中出血量(MD=-27.50 95%CI[-36.89,-18.11],P<0.00001),术后残余液体量(MD=-6.34 95%CI[-8.51,-4.18],P<0.00001),术后引流时间(MD=1.08 95%CI[0.21, 1.95],P=0.01),治愈率(RR=1.22 95%CI[1.07, 1.40],P=0.004)及并发症(RR=0.23 95%CI[0.11, 0.48],P<0.0001)和复发率(RR=0.29 95%CI[0.16, 0.53],P<0.0001)等方面均具有统计学意义,而分析显示纳入研究不存在发表偏倚。结论 微创穿刺引流术在手术时间﹑术后残余液体量,术后引流时间及治愈率方面明显优于传统钻孔引流术,且微创穿刺引流术能明显减少术后并发症及血肿复发。

Abstract:

Objective To compare the efficacy and prognosis between minimally invasive puncture and traditional trepanation and drainage in the treatment of chronic subdural hematoma.Methods According to the inclusion and exclusion criteria, the quality of literature was evaluated strictly. The ReMan 5.0 software was used to perform meta-analysis of enrolled clinical randomized control trials (RCTs).Results Eleven clinical RCTs with a total of 909 patients were enrolled as subjects. There were significant differences in operation time, amount of intraoperative bleeding, amount of residual liquid after operation, postoperative drainage time, cure rate, incidence of complications, and recurrence rate between the two surgical approaches (MD=-28.31, 95%CI [-29.53,-27.09], P <0.00001; MD=-27.50, 95%CI [-36.89,-18.11], P<0.00001; MD=-6.34, 95%CI [-8.51,-4.18], P<0.00001; MD=1.08, 95%CI [0.21, 1.95], P=0.01; RR=1.22, 95%CI [1.07, 1.40], P=0.004; RR=0.23, 95%CI [0.11, 0.48], P<0.0001; RR=0.29, 95%CI [0.16, 0.53], P<0.0001). According to the analyses, there was no publication bias in enrolled studies.Conclusions Minimally invasive puncture and drainage is substantially superior in operation time, amount of residual liquid after operation, postoperative drainage time, and cure rate compared with traditional trepanation and drainage. Furthermore, minimally invasive puncture and drainage can substantially reduce postoperative complications and hematoma recurrence.