Xia Zhiwei, Wu Xinlong, Li Jing, Liu Zhixiong, Chen Fenghua, Zhang Longbo, Zhang Hongfu, Wan Xin, Cheng Quan
Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Neurosurgery, XinJiang Karamay DuShanZi People's Hospital, Karamay, Xinjiang, China.
World Neurosurg. 2018 Jul;115:266-273. doi: 10.1016/j.wneu.2018.04.181. Epub 2018 May 3.
Outcomes of minimally invasive surgery (MIS) versus conventional craniotomy (CC) for patients with spontaneous supratentorial intracerebral hemorrhage (SICH) have not been compared previously. We reviewed the current evidence regarding the safety and efficacy of MIS compared with CC in patients with SICH.
We conducted a meta-analysis of studies comparing MIS and CC in patients with computed tomography-confirmed SICH published between January 2000 and April 2018 in MEDLINE, Embase, and the Cochrane Controlled Trials Register based on PRISMA inclusion and exclusion criteria. Binary outcomes comparisons between MIS and CC were described using odds ratios (ORs).
Five randomized controlled trials (RCTs) and 9 prospective controlled studies (non-RCTs), involving a total of 2466 patients, met our inclusion criteria. There was a statistically significant difference in mortality rate between MIS and CC (OR, 0.76; 95% confidence interval [CI], 0.60-0.97). MIS was associated with a lower rate of rebleeding (OR, 0.42; 95% CI, 0.28-0.64) and a higher rate of good recovery compared with CC (OR, 2.27; 95% CI, 1.34-3.83).
Patients with SICH may benefit more from MIS than CC. Our study could help clinicians optimize treatment strategies in SICH.
此前尚未比较过微创外科手术（MIS）与传统开颅手术（CC）治疗自发性幕上脑出血（SICH）患者的疗效。我们回顾了有关MIS与CC治疗SICH患者安全性和有效性的现有证据。
我们根据PRISMA纳入和排除标准，对2000年1月至2018年4月期间发表在MEDLINE、Embase和Cochrane对照试验注册库中，比较MIS和CC治疗计算机断层扫描确诊的SICH患者的研究进行了荟萃分析。使用比值比（OR）描述MIS和CC之间的二元结局比较。
五项随机对照试验（RCT）和九项前瞻性对照研究（非RCT），共纳入2466例患者，符合我们的纳入标准。MIS和CC之间的死亡率存在统计学显著差异（OR，0.76；95%置信区间[CI]，0.60 - 0.97）。与CC相比，MIS的再出血率较低（OR，0.42；95% CI，0.28 - 0.64），良好恢复率较高（OR，2.27；95% CI，1.34 - 3.83）。
SICH患者可能从MIS中比从CC中获益更多。我们的研究有助于临床医生优化SICH的治疗策略。
