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内镜下第三脑室造瘘术与脑室腹腔分流术治疗脑积水的疗效比较
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Abstract:
背景：脑室腹腔分流术(VPS)和内镜下第三脑室造瘘术(ETV)是目前治疗脑积水最常用的手术方法。但这两种手术方式在治疗脑积水的疗效和安全性现仍旧存在一定的争议。本研究旨在了解ETV是否可以比VPS更安全更有效地治疗脑积水，并进一步指导临床实践。方法：2022年1月在欧洲的Embase数据库、美国的PubMed数据库和英国的Cochrane图书馆3个电子数据库中检索了从1999年1月1日至2021年12月31日的文献数据。在这项系统综述中比较了ETV和VPS治疗脑积水的临床结果、疗效和安全性。患者症状的部分或完全缓解症状或不需要额外手术被视为手术成功。通过随机效应模型计算P值。并使用Cochrane Q检验和I2值评估数据异质性。亚组分析探索数据异质性来源。结果：本次研究总共纳入28项研究(其中6项随机对照试验(RCT)和22项队列研究)。对于VPS和ETV的治疗效果而言，RCT的相对风险危险度(risk ratio, RR)为2.08，95%CI (1.31, 3.32)，而队列研究为1.02，95%CI (0.88, 1.18)，总体的P-interaction为0.55；提示这两种治疗方式的治疗效果在统计学上没有显著差异。并且在VPS和ETV并发症方面，队列研究为RR：0.67，95%CI (0.31, 1.42)；而RCT为RR：1.06，95%CI (0.66, 1.80)，总体的P-interaction是0.84；同样也在统计学上没有显著差异。随后通过对并发症进一步分组发现，感染组中，ETV术后的感染率可能低于VPS (RR: 0.37, 95%CI: 0.19, 0.73)；P-interaction为0.004；具有明显的统计学意义。结论：根据本荟萃分析，ETV和VPS在治疗脑积水患者中的失败率和总体并发症发生率相似。但是在术后感染率方面ETV的感染率可能比VPS更低。
Background: VPS and ETV are the most commonly used surgical methods to treat hydrocephalus. But their efficacy and safety are controversial. This study aimed to find out whether ETV provides patients with hydrocephalus with greater safety and effectiveness than VPS. Methods: In January 2022, searches were conducted in three electronic databases: Embase, PubMed, and Cochrane Li-brary. From January 1, 1999 to December 30, 2021, ETV and VP were compared in terms of clinical outcome, efficacy, and safety in the treatment of hydrocephalus in a systematic review. Partially or completely relieving symptoms or not requiring additional surgery was considered surgical success. Random effects were used to calculate pooled effect estimates. The Cochrane Q test and the I2 value were used to assess heterogeneity. Analyses of subgroups were used to explore heterogeneity sources. Results: An analysis of 28 studies (6 randomized control trials (RCT) and 22 cohort studies) was conducted. Comparing VPS and ETV, a pooled relative risk (RR) of 2.08, 95%CI (1.31, 3.32) for RCT and 1.02, 95%CI (0.88, 1.18) for cohort studies did not differ statistically significantly; P-interaction is 0.55. There was no statistically significant difference in complications between ETV and VPS in cohort studies (RR: 0.67, 95%CI: 0.31, 1.42) or RCTs (RR: 1.06, 95%CI: 0.66, 1.80); P-interaction is 0.84. In infection group ETV may be better than VPS (RR: 0.37, 95%CI: 0.19, 0.73); P-interaction is 0.004. Conclusion: According to this meta-analysis, ETV and VPS have similar failure and complication rates in patients with hydrocephalus, but ETV may get a lower infection rate than VPS.
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