Vychopen Martin, Arlt Felix, Güresir Erdem, Wach Johannes
Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
Comprehensive Cancer Center Central Germany, University Hospital Leipzig, Leipzig, Germany.
Front Oncol. 2024 Aug 29;14:1464671. doi: 10.3389/fonc.2024.1464671. eCollection 2024.
Cranial meningioma surgeries often involve significant blood loss and transfusions. Tranexamic acid (TXA) has been used to reduce blood loss in various surgeries. This meta-analysis of randomized placebo-controlled trials (RCTs) evaluates the impact of TXA in cranial meningioma surgery.
Pubmed, Web of Science, and Cochrane Library were searched for RCTs. Studies were compared for: Blood loss, operative time, hospital stay, reoperation rates, allogeneic and autologous transfusion, and incidence of complications.
Seven RCTs with 490 patients receiving TXA and 491 receiving placebos were included. TXA significantly shortened operative time (Mean Difference (MD): -20.95; 95%CI: -39.94 to -1.95; p=0.03). Blood loss was lower with TXA (MD: -262.7 ml; 95%CI: -397.6 to -127.8; p=0.0001). Odds of reoperation were not significantly different (OR: 0.44; 95%CI: 0.13-1.45; p=0.18). TXA significantly reduced the need for RBC transfusions (OR: 0.47; 95%CI: 0.22-0.99; p<0.05). No significant differences were observed regarding postoperative seizures (OR: 1.06; 95%CI: 0.56-2.03; p=0.85), hydrocephalus (OR: 0.25; 95%CI: 0.03-2.29; p=0.22), or hematoma (OR: 0.52; 95%CI: 0.22-1.28; p=0.16). Hospital stay was shortened in the TXA group (MD: -1.23; 95%CI: -2.41 to -0.05; p=0.04).
This meta-analysis suggests that a single intraoperative dose of TXA reduces blood loss, allogeneic blood transfusions and shortens surgery time.
颅脑膜瘤手术常常涉及大量失血和输血。氨甲环酸（TXA）已被用于减少各类手术中的失血。这项对随机安慰剂对照试验（RCT）的荟萃分析评估了TXA在颅脑膜瘤手术中的影响。
检索了PubMed、科学网和考克兰图书馆中的RCT。对各研究在以下方面进行比较：失血量、手术时间、住院时间、再次手术率、异体和自体输血以及并发症发生率。
纳入了7项RCT，其中490例患者接受TXA治疗，491例接受安慰剂治疗。TXA显著缩短了手术时间（平均差值（MD）：-20.95；95%置信区间：-39.94至-1.95；p = 0.03）。TXA组的失血量更低（MD：-262.7毫升；95%置信区间：-397.6至-127.8；p = 0.0001）。再次手术的几率无显著差异（比值比（OR）：0.44；95%置信区间：0.13 - 1.45；p = 0.18）。TXA显著降低了红细胞输血的需求（OR：0.47；95%置信区间：0.22 - 0.99；p < 0.05）。在术后癫痫发作（OR：1.06；95%置信区间：）、脑积水（OR：0.25；95%置信区间：0.03 - 2.29；p = 0.22）或血肿（OR：0.52；95%置信区间：0.22 - 1.28；p = 0.16）方面未观察到显著差异）。TXA组的住院时间缩短（MD：-1.23；95%置信区间：-2.41至-0.05；p = 0.04）。
这项荟萃分析表明，术中单次使用TXA可减少失血量、异体输血并缩短手术时间。
