内镜下第三脑室造瘘术(ETV)和脑室-腹腔分流术(VPS)是治疗梗阻性脑积水的手术方法。然而,关于最有效的技术仍然存在分歧,在手术成功和术后并发症方面。因此,我们进行了系统评价和荟萃分析,以比较这两种方法在梗阻性脑积水患者中的疗效和安全性.我们对PubMed进行了系统的搜索,Scopus,和Cochrane图书馆数据库。纳入了比较ETV和VPS在儿童或成人梗阻性脑积水患者中的随机临床试验(RCTs)。结果包括手术成功,术后脑脊液漏,术后感染,术后或术中出血,阻塞率,和死亡率。以95%置信区间(CI)计算风险比(RR)。异质性用I2统计数据进行评估。我们对I2<25%的结果使用固定效应模型,对其他条件使用DerSimonian和Laird随机效应模型。在随机试验中评估偏倚风险的Cochrane协作工具用于偏倚风险评估。R,版本4.2.1用于统计分析。在2353项确定的研究中,包括5项RCT,涉及310例梗阻性脑积水,其中163人接受了ETV。ETV对术后感染的支持存在显着差异(风险比[RR]:0.11;95%置信区间[CI]:0.04-0.33;p<0.0001;I2=0%)和阻塞率(RR:0.15;95%CI:0.03-0.75;p=0.02;I2=53%)。同时,术后或术中出血组间无显著差异(RR:0.44;95%CI:0.17-1.15;p=0.09;I2=0%),术后脑脊液漏(RR:0.65;95%CI:0.22-1.92;p=0.44;I2=18%),手术成功率(RR:1.18;95%CI:0.77-1.82;p=0.44;I2=84%),和死亡率(RR:0.19;95%CI:0.03-1.09;p=0.06;I2=0%)。由于随机化过程和报告结果的选择,三个RCT对偏倚风险有一些担忧,一个RCT具有高偏倚风险。因此,这项对评估ETV与VPS比较的RCT的荟萃分析表明,尽管ETV在手术成功方面没有优势,VPS患者的并发症发生率明显较高.我们的结果表明,使用ETV为梗阻性脑积水的治疗提供了更大的益处。然而,需要更多的RCT来证实ETV的优越性。
Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are surgical methods for treating obstructive hydrocephalus. However, there is still disagreement regarding the most effective technique, in terms of both operative success and postoperative complications. Therefore, we performed a systematic review and meta-analysis to compare the efficacy and safety of these two methods in patients with obstructive hydrocephalus. We performed a systematic search of the PubMed, Scopus, and Cochrane Library databases. Randomized clinical trials (RCTs) comparing ETV and VPS in pediatric or adult patients with obstructive hydrocephalus were included. The outcomes included were operative success, postoperative cerebrospinal fluid leak, postoperative infection, postoperative or intraoperative bleeding, blockage rate, and mortality. The risk ratio (RR) was calculated with a 95% confidence interval (CI). Heterogeneity was evaluated with I 2 statistics. We used a fixed-effects model for outcomes with I 2 < 25% and DerSimonian and Laird random-effects model for other conditions. The Cochrane collaboration tool for assessing the risk of bias in randomized trials was used for risk-of-bias assessment. R, version 4.2.1, was used for statistical analyses. Of the 2,353 identified studies, 5 RCTs were included, involving 310 patients with obstructive hydrocephalus, of which 163 underwent ETV. There was a significant difference in favor of ETV for postoperative infection (risk ratio [RR]: 0.11; 95% confidence interval [CI]: 0.04-0.33; p < 0.0001; I 2 = 0%) and blockage rate (RR: 0.15; 95% CI: 0.03-0.75; p = 0.02; I 2 = 53%). Meanwhile, there was no significant difference between groups for the postoperative or intraoperative bleeding (RR: 0.44; 95% CI: 0.17-1.15; p = 0.09; I 2 = 0%), postoperative cerebrospinal fluid leak (RR: 0.65; 95% CI: 0.22-1.92; p = 0.44; I 2 = 18%), operative success (RR: 1.18; 95% CI: 0.77-1.82; p = 0.44; I 2 = 84%), and mortality (RR: 0.19; 95% CI: 0.03-1.09; p = 0.06; I 2 = 0%). Three RCTs had some concerns about the risk of bias and one RCT had a high risk of bias due to the process of randomization and selection of reported results. Thus, this meta-analysis of RCTs evaluating ETV compared with VPS demonstrated that although there is no superiority of ETV in terms of operative success, the incidence of complications was significantly higher in patients who underwent VPS. Our results suggest that the use of ETV provides greater benefits for the treatment of obstructive hydrocephalus. However, more RCTs are needed to corroborate the superiority of ETV.