两种手术方式治疗Chiari畸形Ⅰ型的对比-Meta分析

发布时间：2018-03-18 22:26

本文选题：小脑扁桃体下疝畸形I型　切入点：后颅窝减压伴硬脑膜扩大成形术　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:小脑扁桃体下疝畸形I型(CM-I)是一种常见的后颅窝先天性畸形,儿童和成人均可发病,常伴有脊髓空洞的发生。对于有明显症状/体征的患者行后颅窝减压伴硬脑膜成形术(posterior fossa decompression and duraplasty,PFDD)或硬脑膜外层切开减压术(dural splitting decompression,DSD)均能明显缓解临床症状,但目前尚无关于以上两种术式疗效的大样本、多中心的随机对照试验。该Meta分析的目的是比较PFDD和DSD这两种手术方式术后患者的症状/体征缓解、手术相关并发症发生、脊髓空洞缩小、再手术率等。方法:通过计算机检索2005.01.01-2015.12.31发表在Pub Med、EMBASE、Cochrane、万方、中国知网等数据库的文献。由两名研究者按照纳入、排除标准对文献进行独立筛选,并采用Newcastle-Ottawa量表对纳入的文献进行质量评价,然后提取数据用Rev Man 5.3软件进行数据分析。结果:最终纳入5篇文献,共有230例,其中DSD组129例,PFDD组101例。对纳入研究使用固定效应模型Mantel-Haenszel法进行Meta分析,结果显示两组患者术后症状/体征缓解率无明显统计学差异[OR=0.69,95%CI(0.33,1.42),P=0.31];比较两种术式术后脊髓空洞缩小情况无明显统计学差异[OR=0.94,95%CI(0.29,3.11),P=0.92];而比较两种术式的手术相关并发症显示DSD组并发症发生率较PFDD组更低,且有统计学差异[OR=0.29,95%CI(0.09,0.91),P=0.03];两种手术方式再手术率无明显统计学差异[OR=0.53,95%CI(0.13,2.15),P=0.37]。结论:在治疗CM-I型时,除DSD术后并发症发生率较PFDD低之外,两种手术方式在术后症状/体征缓解率、脊髓空洞缩小率、再手术率等结果指标上无明显差异。但是,由于受原始研究质量、数量限制,以上结论尚需多中心、大样本的随机对照试验进一步验证。
[Abstract]:Objective: type I subtonsillar hernia deformity (CM-I) is a common congenital malformation of posterior cranial fossa, which is common in children and adults. Syringomyelia is often associated with syringomyelia. For patients with obvious symptoms / signs, patients undergoing posterior fossa decompression and dura plastic surgery (PFDD) or dural splitting decompression with dural decompression can significantly relieve the clinical symptoms. However, there is no large sample of the results of the two operations, a multicenter randomized controlled trial. The purpose of this Meta analysis is to compare the symptoms / signs relief and complications associated with the operation between PFDD and DSD. Methods: from January to December 31, 2005.01.01-2015.12.31, 2005.01.01-2015.12.31, methods: the literatures published in Pub Medmassie Cochrane, Wanfang, China Zhiwang and other databases were searched by two researchers according to the inclusion and exclusion criteria. The quality of the included literature was evaluated with Newcastle-Ottawa scale, and the data was extracted and analyzed by Rev Man 5.3 software. Results: finally, 5 articles were included, a total of 230 cases were included. Among them, there were 129 cases in DSD group and 101 cases in PFDD group. The fixed effect model Mantel-Haenszel method was used to analyze Meta in the inclusion study. The results showed that there was no significant difference in the remission rate of symptoms / signs between the two groups [OR0.69 ~ 95CI0.331.42% P0. 31], and there was no significant difference in the reduction of syringomyelia between the two kinds of operation methods [OR0.9495CII 0.293.11P0.92], and the operative complications of the two operations showed DSD. The incidence of complications in group A was lower than that in group PFDD. There was no significant difference in the rate of reoperation between the two kinds of operation methods (OR0.5395). Conclusion: in the treatment of CM-I type, the incidence of postoperative complications of DSD is lower than that of PFDD, and the remission rate of symptoms / signs of the two kinds of operation methods is lower than that of PFDD. There was no significant difference in the reduction rate of syringomyelia and the rate of reoperation. However, due to the limitation of the quality and quantity of the original study, the above conclusions need to be further verified by a multicenter, large sample randomized controlled trial.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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