背景:颅骨融合症,颅面发育异常,由于一个或多个颅骨缝合线的过早闭合,会损害大脑发育并导致颅骨形状异常。传统的手术治疗已经从开放手术发展到微创内窥镜技术。本系统评价和荟萃分析旨在评估内窥镜方法在颅骨融合矫正中的有效性和安全性。
方法:坚持CochraneGroup标准和PRISMA框架,这篇评论利用了像PubMed这样的数据库,Embase,和WebofScience,重点关注截至2023年12月的内窥镜颅骨融合手术的临床和手术结果。纳入标准强调至少5例患者接受内镜手术的研究,虽然排除标准涉及非英语论文,不完整的文本,和重叠的数据。统计分析使用R软件和各种软件包,方法偏差使用ROBINS-I框架进行评估。
结果:该综述包括30项研究(4项前瞻性,26例回顾性)与2561例患者。手术年龄中位数为3.20个月。结果显示平均手术时间为68.06分钟,中位住院时间为1.28天,平均失血量为29.89ml。9.97%的病例需要输血。手术后头盔治疗很常见,中位持续时间为9个月。术后并发症发生率为1.86%,再次手术率为3.07%。没有观察到手术相关的死亡率。该研究指出,颅骨融合的处理存在很大差异,并且在最佳时机和手术方法上缺乏共识。
结论:用于颅骨融合修复的内窥镜技术证明了安全性和有效性,其特点是并发症风险低,手术效果良好。然而,由于观察性研究的局限性和固有的异质性,需要进一步的综合和对照试验来验证这些发现,并了解内镜方法的长期结局.
Craniosynostosis, a developmental craniofacial anomaly, can impair brain development and cause abnormal skull shape due to premature closure of one or more cranial sutures. Traditional surgical treatments have evolved from open operations to minimally invasive endoscopic techniques. This systematic review and meta-analysis aim to evaluate the effectiveness and safety of the endoscopic approach in craniosynostosis correction.
Adhering to Cochrane Group standards and the PRISMA framework, this review utilized databases like PubMed, Embase, and Web of Science, focusing on clinical and surgical outcomes of endoscopic craniosynostosis operations up to December 2023. Inclusion criteria emphasized studies with at least five patients undergoing endoscopic procedures, while exclusion criteria involved non-English papers, incomplete texts, and overlapping data. Statistical analysis used R software with various packages, and methodological bias was assessed using the ROBINS-I framework.
The review included 30 studies (4 prospective, 26 retrospective) with 2561 patients. The median age at operation was 3.20 months. Findings showed a mean operative time of 68.06 min, median hospital stay of 1.28 days, and mean blood loss of 29.89 ml. Blood transfusion was required in 9.97% of cases. Helmet therapy post-operation was common, with a median duration of 9 months. The rate of postoperative complications was 1.86%, and the reoperation rate was 3.07%. No procedure-related mortality was observed. The study noted substantial variations in the handling of craniosynostosis and a lack of consensus on the optimal timing and surgical approach.
Endoscopic techniques for craniosynostosis repair demonstrate safety and effectiveness, characterized by low complication risks and favorable surgical outcomes. However, due to the limitations of observational studies and inherent heterogeneity, further comprehensive and controlled trials are needed to validate these findings and understand the long-term outcomes of the endoscopic approach.