两种术式治疗Chiari畸形Ⅰ型临床疗效比较的Meta分析
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摘要
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.
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.
引文
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[16]张宗永,谭玉堂,欧阳陶辉,等.Chiari畸形Ⅰ型并脊髓空洞症手术治疗策略[J].中华神经外科疾病研究杂志,2017,16(1):69-71.
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[18]包长顺,杨福兵,刘亮,等.Arnold-Chiari畸形Ⅰ型并脊髓空洞症的显微外科治疗[J].中华神经医学杂志,2011,10(10):993-995.
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[20]徐宇伦,吴量,姚宁,等.B超辅助下颅后窝小骨窗减压结合枕大池重建术治疗Arnold-Chiari畸形[J].中国微侵袭神经外科杂志,2010,15(7):308-309.
[21]袁绍纪,李际文,吕学明.Chiari畸形并脊髓空洞术中体感诱发电位联合诱发肌电图监测[J].中国微侵袭神经外科杂志,2005,10(9):389-390.
[2]沈建,徐庆生,叶科,等.两种不同术式治疗Chiari畸形合并脊髓空洞症的疗效分析[J].中华神经外科杂志,2008,24(12):922-924.
[3]李铮,潘保根,崔澄,等.Arnold-Chiari畸形治疗的不同术式疗效比较[J].白求恩军医学院学报,2008,6(4):198-199.
[4]朱青峰,王千,王国芳,等.两种不同手术方法治疗合并脊髓空洞的ChiariⅠ畸形的效果比较[J].中国临床神经外科杂志,2011,16(1):22-24.
[5]王传宝,王跃彬,许建新,等.Chiari-Ⅰ畸形两种手术方式疗效对比研究[J].中国医疗前沿,2011,6(10):7-8.
[6]李荔荣,赵建伟,胡昌辰,等.两种不同手术方法治疗合并脊髓空洞的ChiariⅠ畸形的效果比较[J].中国药物与临床,2013,13(10):1333-1334.
[7]艾克拜尔·亚里坤,乌拉别克·毛力提,刘宇利,等.三种手术方法治疗ChiariⅠ畸形并脊髓空洞的疗效对比[J].中华神经外科杂志,2014,30(12):1271-1274.
[8]周权明,杨小朋,陈刚,等.不同手术方式治疗Chiari畸形Ⅰ型的疗效分析[J].中华临床医师杂志(电子版),201610(9):1219-1223.
[9]樊华声.Arnold-ChiariⅠ型畸形三种不同手术治疗的效果比较[D].南宁:广西医科大学,2016.
[10]沈亚徐.Arnold-Chiari畸形Ⅰ型并脊髓空洞症手术方式的疗效对比[D].南昌:南昌大学,2016.
[11]张建华.两种不同术式治疗Chiari畸形Ⅰ型并脊髓空洞的疗效对比[D].西宁:宁夏医科大学,2017.
[12]贾崇,李红伟,吴俊儒,等.小脑扁桃体软膜下切除术与硬膜扩大修补术治疗ChiariⅠ型畸形并脊髓空洞的疗效观察[J].中国脊柱脊髓杂志,2017,27(11):1013-1018.
[13]MCVIGE J W,LEONARDO J.Imaging of Chiari typeⅠmalformation and syringohydromyelia[J].Neurol Clin,2014,32(1):95-126.
[14]LEVINE D N.The pathogenesis of syringomyelia associated with lesions at the foramen magnum:a critical review of existing theories and proposal of a new hypothesis[J].JNeurol Sci,2004,15,220(1-2):3-21.
[15]杨树源,高永中.脊髓空洞症外科治疗的现状与展望[J]中华神经外科杂志,1998,14(6):327.
[16]张宗永,谭玉堂,欧阳陶辉,等.Chiari畸形Ⅰ型并脊髓空洞症手术治疗策略[J].中华神经外科疾病研究杂志,2017,16(1):69-71.
[17]王楠.Chiari畸形的不同手术方式及疗效对比[D].济南:山东大学,2013.
[18]包长顺,杨福兵,刘亮,等.Arnold-Chiari畸形Ⅰ型并脊髓空洞症的显微外科治疗[J].中华神经医学杂志,2011,10(10):993-995.
[19]STANKO K M,LEE Y M,RIOS J,et al.Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation[J].J Neurosurg Pediatr,2015,17(2):174-181.
[20]徐宇伦,吴量,姚宁,等.B超辅助下颅后窝小骨窗减压结合枕大池重建术治疗Arnold-Chiari畸形[J].中国微侵袭神经外科杂志,2010,15(7):308-309.
[21]袁绍纪,李际文,吕学明.Chiari畸形并脊髓空洞术中体感诱发电位联合诱发肌电图监测[J].中国微侵袭神经外科杂志,2005,10(9):389-390.