Jiang Lin, Gao Guangzhong, Zhou Yanfeng
Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu Province, China.
Medicine (Baltimore). 2018 Oct;97(42):e12139. doi: 10.1097/MD.0000000000012139.
The surgical methods of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VS) for patients with noncommunicating hydrocephalus have rapidly increased in the past 2 decades. However, there is controversy regarding the efficacy and safety of these 2 surgical methods for noncommunicating hydrocephalus. The purpose of this study was to identify whether ETV is safer and more efficacious than VS for patients with noncommunicating hydrocephalus.
We performed electronic searches in PubMed, Embase, China National Knowledge Internet, and the Cochrane Library to identify studies published up to February 03, 2018. The study summary results included improvement of symptoms, major complications, hematoma, infection, reoperation, mortality, duration of surgery, and hospital stay. Odds ratios (ORs) or standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models.
We identified 10 observational studies (4 prospective and 6 retrospective studies) with data collected from 2017 patients with noncommunicating hydrocephalus. First, there was no significant difference between ETV and VS for symptom improvement (OR: 0.83; 95%CI: 0.46-1.50; P = .534). Second, ETV was associated with lower incidence of major complications when compared with VS (OR: 0.31; 95%CI: 0.17-0.56; P < .001). Third, ETV has little or no significant effect on hematoma (OR: 0.65; 95%CI: 0.22-1.92; P = .433) and mortality (OR: 0.90; 95%CI: 0.11-7.72; P = .926). Fourth, ETV were associated with lower incidence of infection (OR: 0.20; 95%CI: 0.06-0.69; P = .010) and reoperation (OR: 0.22; 95%CI: 0.08-0.56; P = .002). Finally, patients who received ETV had shorter duration of surgery (SMD: -1.71; 95%CI: -3.16 to -0.27; P = .020) and hospital stay (SMD: -0.91; 95%CI: -1.45 to -0.38; P = .001).
This meta-analysis provides robust evidence that ETV has greater benefits in terms of major complications, infection, reoperation, duration of surgery, and hospital stay than VS for patients with noncommunicating hydrocephalus.
在过去20年中，用于治疗非交通性脑积水患者的内镜下第三脑室造瘘术（ETV）和脑室腹腔分流术（VS）的手术方法迅速增加。然而，对于这两种治疗非交通性脑积水的手术方法的疗效和安全性存在争议。本研究的目的是确定对于非交通性脑积水患者，ETV是否比VS更安全、更有效。
我们在PubMed、Embase、中国知网和Cochrane图书馆进行了电子检索，以识别截至2018年2月3日发表的研究。研究总结结果包括症状改善、主要并发症、血肿、感染、再次手术、死亡率、手术持续时间和住院时间。使用随机效应模型计算95%置信区间（CI）的比值比（OR）或标准化均数差（SMD）。
我们确定了10项观察性研究（4项前瞻性研究和6项回顾性研究），数据来自2017例非交通性脑积水患者。首先，ETV和VS在症状改善方面没有显著差异（OR：0.83；95%CI：0.46-1.50；P = 0.534）。其次，与VS相比，ETV的主要并发症发生率较低（OR：0.31；95%CI：0.17-0.56；P < 0.001）。第三，ETV对血肿（OR：0.65；95%CI：0.22-1.92；P = 0.433）和死亡率（OR：0.90；95%CI：0.11-7.72；P = 0.926）几乎没有或没有显著影响。第四，ETV的感染发生率（OR：0.20；95%CI：0.06-0.69；P = 0.010）和再次手术发生率（OR：0.22；95%CI：0.08-0.56；P = 0.002）较低。最后，接受ETV治疗的患者手术持续时间较短（SMD：-1.71；95%CI：-3.16至-0.27；P = 0.020），住院时间较短（SMD：-0.91；95%CI：-1.45至-0.38；P = 0.001）。
这项荟萃分析提供了有力证据，表明对于非交通性脑积水患者，ETV在主要并发症、感染、再次手术、手术持续时间和住院时间方面比VS有更大的益处。
