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针对自发性上门内脑出血的手术干预:系统性审查和网络元分析

Jiayidaer Huan^1,2,3,4, Minghong Yao^1,2,3, Yu Ma^1,2,3

¹Department of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China.

EClinicalMedicine

|December 25, 2024

概括

与保守治疗相比,对自发性上门门内脑出血 (ICH) 的手术改善了结果,并降低了死亡率. 最少侵入性手术,特别是内镜手术 (ES),在功能恢复和并发症减少方面显示出显著的好处.

科学领域:

神经外科神经外科
医疗干预医疗干预
公共卫生公共卫生

背景情况:

自发的上门内脑出血 (ICH) 存在重大风险.
手术选择包括传统的切除术 (CC),解压切除术 (DC) 和微创手术 (MIS),如内镜手术 (ES) 和微创穿刺手术 (MIPS).
不同手术方法与保守医学治疗 (CMT) 的比较疗效尚不清楚.

研究的目的:

为了评估各种手术干预的疗效和安全性,自发的 supratentorial ICH.
为了比较手术治疗与保守的医疗管理.
评估不同外科手术技术之间的比较好处.

主要方法:

随机对照试验 (RCT) 的系统审查和网络元分析.
搜索的主要数据库 (PubMed,Cochrane,Embase,ClinicalTrials.gov) 截至 2024 年 6 月 16 日.
评估功能结果,死亡率,并发症和血液瘤疏散率,使用频率师对对和网络元分析,并进行GRADE确定性评估.

主要成果:

与CMT (中等确定性证据) 相比,手术显著改善了功能结果,降低了死亡率.
与CMT相比,内镜手术 (ES) 和最小侵入性穿孔手术 (MIPS) 显示出更好的功能结果.
ES和CC降低了死亡率,而ES和MIPS降低了肺部感染风险;ES显示出更高的血液瘤疏散率.

结论:

对 supratentorial ICH 的手术干预与改善功能结果和降低死亡率有关.
最少侵入性手术 (MIS),特别是ES和MIPS,具有明显的优势.
内镜手术 (ES) 可能是最优的治疗方法,因为改善了结果,降低了死亡率和感染风险,以及高的血液瘤疏散率.

关键词:

脑内出血脑内出血网络元分析网络元分析手术干预是一种手术干预.系统性审查系统性审查

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