在中国，显微镜下与内镜下微血管减压术治疗面肌痉挛的疗效比较：一项荟萃分析和系统评价。

Microscopic versus endoscopic microvascular decompression for the treatment of hemifacial spasm in China: A meta-analysis and systematic review.

机构信息

Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.

出版信息

J Clin Neurosci. 2021 Sep;91:23-31. doi: 10.1016/j.jocn.2021.06.034. Epub 2021 Jun 28.

DOI:10.1016/j.jocn.2021.06.034

PMID:34373033

Abstract

OBJECTIVE

To date, microvascular decompression has become the standard surgical treatment for hemifacial spasm. Microscopic microvascular decompression (MI-MVD) and endoscopic microvascular decompression (E-MVD) are both popular with surgeons. The present study aims to investigate whether MI-MVD and E-MVD show better results as surgical treatments for hemifacial spasm in the Chinese population.

METHODS

Electronic retrieval of articles on PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and Wanfang Database was performed to identify comparative studies on Chinese patients who underwent MI-MVD and E-MVD from January 2000 to December 2020. After data extraction and quality assessment of the included studies, a meta-analysis was performed using the Review Manager 5.4 software. The pooled incidence of patient effective rate, detection rate of offensive blood vessels, total complication rate, and recurrence rate were calculated.

RESULTS

A total of 12 studies with 1122 patients (MI-MVD: 562, E-MVD: 560) were identified. The patient effective rate (MI-MVD: 89% vs E-MVD:97%, OR = 0.22, P < 0.00001) and detection rate of offensive blood vessels (MI-MVD:91% vs E-MVD:98%, OR = 0.17, P = 0.0002) showed patients with E-MVD were significantly higher than patients who underwent MI-MVD. However, the total complication rate (MI-MVD: 27% vs E-MVD:12%, OR = 2.92, P = 0.0002) and recurrence rates (MI-MVD:5.7% vs E-MVD:0.3%, OR = 8.8, P = 0.0005) showed patients with E-MVD were significantly lower than patients who underwent MI-MVD. In addition, the incidence of facial paralysis or weakness and hearing loss in E-MVD group was lower than that of in MI-MVD group, whereas no statistical difference was found between the two groups in terms of the incidence of cerebrospinal fluid leakage and intracranial infection.

CONCLUSIONS

While the operation of MI-MVD is relatively simple and the learning curve is short, E-MVD is better than MI-MVD in terms of treatment effect, overall complications, and recurrence rate. Therefore, E-MVD can be used as an alternative to MI-MVD in the treatment of hemifacial spasm in the Chinese population.

摘要

目的

微血管减压术已成为治疗面肌痉挛的标准手术方法。显微微血管减压术（MI-MVD）和内镜微血管减压术（E-MVD）均受到外科医生的青睐。本研究旨在探讨 MI-MVD 和 E-MVD 作为中国人面肌痉挛的手术治疗方法是否具有更好的效果。

方法

通过电子检索 PubMed、Embase、Cochrane 图书馆、中国知网和万方数据库，收集 2000 年 1 月至 2020 年 12 月期间中国患者接受 MI-MVD 和 E-MVD 的对照研究。对纳入研究进行数据提取和质量评估后，采用 Review Manager 5.4 软件进行荟萃分析。计算患者有效率、致压血管检出率、总并发症发生率和复发率的合并发生率。

结果

共纳入 12 项研究，共计 1122 例患者（MI-MVD：562 例，E-MVD：560 例）。E-MVD 组患者有效率（89%比 MI-MVD 组 97%，OR=0.22，P<0.00001）和致压血管检出率（91%比 MI-MVD 组 98%，OR=0.17，P=0.0002）明显高于 MI-MVD 组。然而，E-MVD 组总并发症发生率（27%比 MI-MVD 组 12%，OR=2.92，P=0.0002）和复发率（5.7%比 MI-MVD 组 0.3%，OR=8.8，P=0.0005）明显低于 MI-MVD 组。此外，E-MVD 组面神经瘫痪或无力和听力损失的发生率低于 MI-MVD 组，而两组脑脊液漏和颅内感染的发生率无统计学差异。