慢性硬膜下血肿不同手术技术的比较：一项网状荟萃分析
Comparison of different surgical techniques for chronic subdural hematoma: a network meta-analysis.
作者信息
Qiu Youjia, Xie Minjia, Duan Aojie, Yin Ziqian, Wang Menghan, Chen Xi, Chen Zhouqing, Gao Wei, Wang Zhong
机构信息
Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.
出版信息
Front Neurol. 2023 Jul 26;14:1183428. doi: 10.3389/fneur.2023.1183428. eCollection 2023.
BACKGROUND
Chronic subdural hematoma (CSDH) is a neurosurgical condition with high prevalence. Many surgical approaches are recommended for treating CSDH, but there needs to be a consensus on the optimal technique. This network meta-analysis (NMA) compared the efficacy and safety of different surgical treatments for CSDH.
METHODS
Electronic databases, including PubMed, Embase, and the Cochrane Library, were searched for relevant studies up to February 2023. An NMA was performed to compare the outcomes of patients with CSDH treated by single-hole or double-hole craniotomy (SBHC and DBHC, respectively), twist-drill craniotomy (TDC), mini-craniotomy, and craniotomy. The NMA protocol was registered at INPLASY (registration no. 202320114).
RESULTS
The NMA included 38 studies with 7,337 patients. For efficacy outcomes, DBHC showed the highest surface under the cumulative ranking area (SUCRA) values for recurrence (96.3%) and reoperation (87.4%) rates. DBHC differed significantly from mini-craniotomy in recurrence rate (odds ratio [OR] = 0.58, 95% confidence interval [CI]: 0.35, 0.97) and from SBHC (OR = 0.48, 95% CI: 0.25, 0.91) and TDC (OR = 0.40, 95% CI: 0.20, 0.82) in reoperation rate. For operative time, TDC was superior to SBHC (mean difference [MD] = -2.32, 95% CI: -3.78 to -0.86), DBHC (MD = -3.61, 95% CI: -5.55, -1.67), and mini-craniotomy (MD = -3.39, 95% CI: -5.70, -1.08). Patients treated by TDC had a shorter hospital stay than those treated by SBHC (MD = -0.82, 95% CI: -1.51, -0.12). For safety outcomes, there were no significant differences between groups in mortality and complication rates; however, mini-craniotomy (79.8%) and TDC (78.1%) had the highest SUCRAs.
CONCLUSION
DBHC may be the most effective surgical treatment for CSDH based on the low recurrence and reoperation rates, although all examined techniques were relatively safe.
SYSTEMATIC REVIEW REGISTRATION
背景
慢性硬膜下血肿（CSDH）是一种神经外科常见疾病。治疗CSDH有多种手术方法，但对于最佳技术尚无共识。本网状Meta分析（NMA）比较了不同手术治疗CSDH的疗效和安全性。
方法
检索电子数据库，包括PubMed、Embase和Cochrane图书馆，截至2023年2月的相关研究。进行NMA以比较经单孔或双孔开颅术（分别为SBHC和DBHC）、锥颅术（TDC）、微创开颅术和开颅术治疗的CSDH患者的结局。NMA方案已在INPLASY注册（注册号：202320114）。
结果
NMA纳入了38项研究，共7337例患者。在疗效结局方面，DBHC在复发率（96.3%）和再次手术率（87.4%）的累积排名曲线下面积（SUCRA）值最高。DBHC与微创开颅术在复发率方面差异显著（比值比[OR]=0.58，95%置信区间[CI]：0.35，0.97），与SBHC（OR=0.48，95%CI：0.25，0.91）和TDC（OR=0.40，95%CI：0.20，0.82）在再次手术率方面差异显著。在手术时间方面，TDC优于SBHC（平均差[MD]=-2.32，95%CI：-3.78至-0.86）、DBHC（MD=-3.61，95%CI：-5.55，-1.67）和微创开颅术（MD=-3.39，95%CI：-5.70，-1.08）。接受TDC治疗的患者住院时间比接受SBHC治疗的患者短（MD=-0.82，95%CI：-1.51，-0.12）。在安全性结局方面，各组在死亡率和并发症发生率上无显著差异；然而，微创开颅术（79.8%）和TDC（78.1%）的SUCRA值最高。
结论
基于低复发率和再次手术率，DBHC可能是治疗CSDH最有效的手术方法，尽管所有检查的技术相对安全。
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