Akhigbe Taiwo, Okafor Uchena, Sattar Taufiq, Rawluk Daniel, Fahey Tom
Department of Neurosurgery, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Neurosurgery, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
World Neurosurg. 2015 Aug;84(2):451-60. doi: 10.1016/j.wneu.2015.03.051. Epub 2015 Apr 7.
Spontaneous intracerebral hemorrhage (SICH) has a high morbidity and mortality and places a huge significant economic burden on health care and social services. The role of surgery is still controversial as evidenced by wide variation internationally in management of SICH. Traditional surgery for SICH involved open craniotomy with hematoma evacuation. Using available evidence, this article assesses the efficacy of stereotactic-guided evacuation compared with medical treatment.
A systematic review was performed comparing stereotactic-guided evacuation of SICH with conservative medical management. Eligible studies were identified using a text word search of an electronic journal database for randomized controlled trials. Extracted data outcomes were subjected to meta-analysis with a forest plot. Quality was assessed using Cochrane risk of bias analysis tools.
There were 5 studies with 740 patients. There was a nonsignificant reduction in odds ratio (OR) for death at the end of the follow-up period (OR = 0.74, 95% confidence interval = 0.45-1.21) with no significant heterogeneity. Nonsignificant benefits were observed for dependent survival (OR = 2.14, 95% confidence interval = 0.31-0.58). In the subgroup analysis, stereotactic evacuation showed improved outcomes in patients with hematoma volume <50 mL. In this review, the effectiveness of stereotactic evacuation plus subsequent thrombolysis was insignificant (OR = 1.34, 95% confidence interval = 0.57-3.12).
The outcome of patients who had stereotactic-guided evacuation of SICH was not better compared with patients who received medical treatment; however, there was a trend toward better quality of survival and chance of survival in the stereotactic-guided evacuation group. This study identified areas for further research.
自发性脑出血（SICH）的发病率和死亡率很高，给医疗保健和社会服务带来了巨大的经济负担。手术的作用仍存在争议，国际上对SICH的治疗方法差异很大就证明了这一点。传统的SICH手术包括开颅血肿清除术。本文利用现有证据，评估立体定向引导下血肿清除术与药物治疗相比的疗效。
进行了一项系统评价，比较立体定向引导下SICH血肿清除术与保守药物治疗。通过对电子期刊数据库进行文本词搜索，以识别随机对照试验的合格研究。提取的数据结果采用森林图进行荟萃分析。使用Cochrane偏倚风险分析工具评估质量。
有5项研究，共740例患者。随访期末死亡的优势比（OR）有非显著性降低（OR = 0.74，95%置信区间 = 0.45 - 1.21），且无显著异质性。在依赖生存方面观察到非显著性益处（OR = 2.14，95%置信区间 = 0.31 - 0.58）。在亚组分析中，立体定向血肿清除术在血肿体积<50 mL的患者中显示出更好的结果。在本综述中，立体定向血肿清除术加后续溶栓的有效性不显著（OR = 1.34，95%置信区间 = 0.57 - 3.12）。
与接受药物治疗的患者相比，接受立体定向引导下SICH血肿清除术的患者结局并未更好；然而，立体定向引导下血肿清除术组在生存质量和生存机会方面有改善趋势。本研究确定了进一步研究的领域。
