开颅视神经减压术与内镜下视神经减压术 疗效的Meta 分析

Optic canal decompression via open cranial surgery versus endoscopic surgery in treatment of traumatic optic nerve injury: a systematic review and Meta-analysis

摘要:

目的 系统性评价开颅与内镜下视神经减压术对创伤性视神经损伤患者视力改善的影响。方法 采用系统性回顾和Meta 分析方法。收集1980 ～ 2017 年国内外相关研究，共纳入文献40 篇、患者3 199 例。 采用Comprehensive meta analysis 2.0 对结果进行分析。结果 开颅视神经减压术有效率为59.1%[O^R=0.591 （95%CI ：0.548，0.633），P =0.000]，内镜手术有效率为54.1%[O^R=0.541（95%CI ：0.520，0.563），P =0.000]。 两种手术有效率比较，差异有统计学意义（χ2=8.163，P =0.040）；开颅手术预后优于内镜下减压术。亚组分 析中视神经管骨折与手术效果无关，手术时机<7 d 及术前视力> 无光感（NLS）组效果较好。结论 开颅视 神经减压术手术效果优于内镜手术，手术时机应尽早，术前有光感患者预后较好。

Abstract:

Objective To systemically review the effect of optic canal decomposition surgery by trans-cranial or endoscopic method in the treatment of traumatic optic canal injury. Methods Related articles published from1980 to 2017 were involved in this study. A total of 48 literaturesand 3,199 subjects were included. Therapeutic effect of two surgical methods were compared with comprehensive meta-analysis 2.0. Statistical significance was identified by χ2 test. Result Efficacy of open cranial surgery was [O^R = 0.591 (95%CI: 0.548, 0.633), P = 0.000] and that was [O^R = 0.541 (95%CI: 0.520, 0.5630), P = 0.000] in the endoscopic surgery. χ2 test shows that the open cranial surgery was more efficient (χ2 = 8.163, P = 0.040) compared with endoscopic surgery. Subgroup analysis indicated that timing of surgery (patients < 7 d) and vision before surgery > NLS affected the postoperative recovery. Optic canal fracture didnot interfere the outcome. Conclusion The optic canal decompression by open cranial surgery exerts better therapeutic effect, and the patients with vision before surgery > no light-sensitive (NLS) and receiving surgery within 7 days experience better recovery.