第三脑室底造瘘术与脑室-腹腔分流术治疗儿童脑积水效果的Meta分析
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摘要
目的探讨第三脑室底造瘘术(ETV)与脑室-腹腔分流术(VPS)两种术式治疗儿童脑积水的临床效果。方法通过计算机检索中国知网、万方数据知识服务平台、维普数据库、PubMed、Embase、Cochrane library数据库,按照纳入和排除标准获取从建库到2018年10月收录的相关文献,采用Newcastle-Ottawa量表及Jadad量表进行文献的质量评价,使用Stata 15.0软件进行Meta分析。结果 ETV与VPS治疗儿童脑积水手术有效率(OR=1.50,95%CI:0.82~2.74,P=0.189)、术后总并发症的发生率(OR=0.73,95%CI:0.36~1.51,P=0.394)、术后颅内血肿发生率(OR=1.16,95%CI:0.51~2.66,P=0.726)比较,差异无统计学意义,术后颅内感染发生率(OR=0.27,95%CI:0.12~0.57,P=0.001)、术后分流阻塞发生率(OR=0.17,95%CI:0.06~0.43,P=0.000)及术后再次手术率(OR=0.20,95%CI:0.07~0.56,P=0.002)比较,差异有统计学意义。结论 ETV在术后并发症及是否再次手术方面优于VPS,更多优势仍需进一步临床研究观察。
Objective To investigate the clinical effects of the third ventriculostomy(ETV) and ventriculoperitoneal shunt(VPS) in the treatment of hydrocephalus in children. Methods Relevant literatures collected from the establishment of the database to October 2018 were obtained according to inclusion and exclusion criteria through computer retrieval of China national knowledge network, Wanfang data knowledge service platform, VIP database, PubMed, Embase and Cochrane library databases. The Newcastle-Ottawa scale and Jadad scale were used for literature quality evaluation, and Stata 15.0 software was used for Meta analysis. Results There was no statistically significant difference in the effective rate(OR = 1.50, 95%CI: 0.82-2.74, P = 0.189), the incidence of total postoperative complications(OR = 0.73,95%CI: 0.36-1.51, P = 0.394), the incidence of intracranial hematoma after operation(OR = 1.16, 95%CI: 0.51-2.66,P = 0.726) of ETV and VPS in the treatment of hydrocephalus in children. The incidence of postoperative intracranial infection(OR = 0.26, 95%CI: 0.12-0.57, P = 0.001), the incidence of postoperative shunt obstruction(OR = 0.17, 95%CI: 0.06-0.43, P = 0.000), the rate of reoperation after operation(OR = 0.20, 95%CI: 0.07-0.56, P = 0.002) were statistically significant. Conclusion ETV is superior to VPS in postoperative complications and whether or not to have another operation. More advantages still need to be further observed in clinical studies.
Objective To investigate the clinical effects of the third ventriculostomy(ETV) and ventriculoperitoneal shunt(VPS) in the treatment of hydrocephalus in children. Methods Relevant literatures collected from the establishment of the database to October 2018 were obtained according to inclusion and exclusion criteria through computer retrieval of China national knowledge network, Wanfang data knowledge service platform, VIP database, PubMed, Embase and Cochrane library databases. The Newcastle-Ottawa scale and Jadad scale were used for literature quality evaluation, and Stata 15.0 software was used for Meta analysis. Results There was no statistically significant difference in the effective rate(OR = 1.50, 95%CI: 0.82-2.74, P = 0.189), the incidence of total postoperative complications(OR = 0.73,95%CI: 0.36-1.51, P = 0.394), the incidence of intracranial hematoma after operation(OR = 1.16, 95%CI: 0.51-2.66,P = 0.726) of ETV and VPS in the treatment of hydrocephalus in children. The incidence of postoperative intracranial infection(OR = 0.26, 95%CI: 0.12-0.57, P = 0.001), the incidence of postoperative shunt obstruction(OR = 0.17, 95%CI: 0.06-0.43, P = 0.000), the rate of reoperation after operation(OR = 0.20, 95%CI: 0.07-0.56, P = 0.002) were statistically significant. Conclusion ETV is superior to VPS in postoperative complications and whether or not to have another operation. More advantages still need to be further observed in clinical studies.
引文
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[18] Chugh A,Husain M,Gupta RK et al. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy:prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy[J]. J Neurosurg Pediatr,2009,3(5):371-377.
[19]张亚卓.神经内镜手术技术[M].北京:北京大学医学出版社,2004:36-55.
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[21]洗丹霞,林美英,金宇,等.社区6~36月龄儿童社会生活能力发展状况调查[J].中国心理卫生杂志,2013,27(6):457-461.
[2] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses[J]. Eur J Epidemiol,2010,25(9):603-605.
[3] Jadad AR,Moore RA,Carroll D. Assessing the quality of reports of randomized clinical trials:is blinding necessary[J].Control Clin Trials,1996,17(1):1-12
[4]李建国,魏新亭.神经内镜三脑室底造瘘术与脑室腹腔分流术对婴幼儿梗阻性脑积水的治疗效果比较[J].河南外科学杂志,2018,24(2):47-49.
[5]陈海新.2岁以下小儿脑积水两种手术方式的疗效比较[D].昆明:云南中医学院,2018.
[6]吉文玉.V-PS手术与ETV手术治疗儿童先天性脑积水认知障碍的对比研究[D].乌鲁木齐:新疆医科大学,2016.
[7]廖佳奇,温小华,涂勇,等.内镜下三脑室底造瘘术治疗小儿梗阻性脑积水的疗效观察[J].中国临床研究,2012,25(11):1055-1056.
[8]江峰.婴幼儿阻塞性脑积水的临床研究[D].上海:上海交通大学,2009.
[9]冯书彬,齐林,吕强,等.三脑室底造瘘术和脑室腹腔分流术治疗儿童脑积水疗效分析[J].中国实用神经疾病杂志,2017,20(24):70-74.
[10] Goyal P,srivastava C,Ojha BK,et al. A randomized study of ventriculoperitoneal shunt versus endoscopic third ventriculostomy for the management of tubercular meningitis with hydrocephalus[J]. Childs Nerv Syst,2014,30(5):851-857.
[11] de Ribaupierre S,Rilliet B,Vernet O,et al. Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus:results from a Swiss series and literature review[J]. Childs Nerv Syst,2007,23(5):527-533.
[12] El-Ghandour NM. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children[J]. Childs Nerv Syst,2011,27(1):117-126.
[13] Appelgren T,Zetterstrand S,Elfversson J,et al. Longterm outcome after treatment of hydrocephalus in children[J]. Pediatr Neurosurg,2010,46(3):221-226.
[14] Kulkarni AV,Schiff SJ,Kulkarni AV,et al. Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda[J]. N Engl J Med,2017,377(25):2456-2464.
[15] Uche EO,Okorie C,Iloabachie I,et al. Endoscopic third ventriculostomy(ETV)and ventriculoperitoneal shunt(VPS)in non-communicating hydrocephalus(NCH):comparison of outcome profiles in Nigerian children[J].Childs Nerv Syst,2018,34(9):1683-1689.
[16]中国医师协会神经外科医师分会.中国脑积水规范化治疗专家共识(2013版)[J].中华神经外科杂志,2013,29(6):634-637.
[17] Singla A,Lin N,Ho AL,et al. Vascular collateralication along ventriculoperitoneal shunt catheters in moyamoya disease[J]. J Neurosurg Pediatr,2013,11(6):710-712.
[18] Chugh A,Husain M,Gupta RK et al. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy:prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy[J]. J Neurosurg Pediatr,2009,3(5):371-377.
[19]张亚卓.神经内镜手术技术[M].北京:北京大学医学出版社,2004:36-55.
[20] Radim L,Tomas P,Stefan R,et al. Death in consequence of late failure of endoscopic third ventriculostomy[J].Childs Nerv Syst,2007,23:815-819.
[21]洗丹霞,林美英,金宇,等.社区6~36月龄儿童社会生活能力发展状况调查[J].中国心理卫生杂志,2013,27(6):457-461.