目的:在本系统综述和荟萃分析中,作者旨在直接比较开腹手术和内窥镜辅助技术治疗矢状位颅骨融合症,关注失血的结果,输血率,逗留时间,操作时间,并发症发生率,成本,和美容结果。
方法:根据系统评价和荟萃分析(PRISMA)指南的首选报告项目进行了文献检索。从3个电子数据库(MEDLINE,EMBASE,和CENTRAL[Cochrane中央受控试验登记册])从成立到2017年8月。使用定量研究的有效公共卫生实践项目质量评估工具评估方法和偏差风险。组间的效果估计值以95%CIs的标准化平均差计算。随机和固定效应模型用于估计总体效应。
结果:在316条筛选记录中,10符合纳入标准,其中3项纳入荟萃分析.这些研究报告了303例接受内窥镜治疗的患者和385例接受开放手术治疗的患者。内镜手术与较低的估计失血量相关(p<0.001),住院时间较短(p<0.001),和更短的操作时间(p<0.001)。从10项研究的文献综述来看,内镜手术的输血率一直较低,6项研究中有4项存在显著差异;成本较低,在3项研究中的3项研究中,差异从11,603美元到31,744美元不等;在3项研究中的3项研究中,美容结果是模棱两可的(p>0.05)。最后,在8项研究中的8项,内镜技术显示并发症发生率与开放手术相似或低于开放手术.
结论:内镜手术与较低的估计失血有关,操作时间,在医院的日子。未来的长期前瞻性注册可能会在并发症和成本方面建立优势,具有等效的美容效果。显示了评估患者或父母报告的满意度,最佳干预时机以及结果异质性的大型研究。
OBJECTIVE: In this systematic
review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome.
METHODS: A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect.
RESULTS: Of 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature
review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies.
CONCLUSIONS: Endoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.