神经内镜辅助下小骨窗开颅术与传统钻孔术治疗慢性硬膜下血肿的临床疗效Meta分析

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目的通过Meta分析评价神经内镜辅助下小骨窗开颅术与传统钻孔术治疗慢性硬膜下血肿(CSDH)的临床疗效。方法采用计算机检索中国知网、万方数据、维普网、PubMed、EMbase、Cochrane Library等中、英文数据库，时间从建库至2021年11月。选取包含神经内镜辅助下小骨窗开颅术与传统钻孔术治疗CSDH的临床研究，使用RevMan 4.2软件对数据进行Meta分析。结果共纳入22篇文献，包括400例分隔型CSDH患者和1 369例CSDH患者。Meta分析结果显示，神经内镜辅助下小骨窗开颅术治疗分隔型CSDH的术后复发率低于传统钻孔术（OR=0.17，95%CI：0.08~0.35，P<0.000 01），术后并发症率低于传统钻孔术（OR=0.13，95%CI：0.06~0.28，P<0.000 01）。神经内镜辅助下小骨窗开颅术治疗CSDH的术后复发率低于传统钻孔术（OR=0.16，95%CI：0.10~0.26，P<0.000 01），术后并发症率低于传统钻孔术（OR = 0.15，95%CI：0.10~0.23，P<0.000 01）。结论与传统钻孔术相比，神经内镜辅助下小骨窗开颅术治疗分隔型CSDH和CSDH，具有血肿复发率更低和术后并发症更少的优势。分隔型CSDH应首选神经内镜辅助下小骨窗开颅术。非分隔型CSDH应首选传统钻孔术。

ObjectiveTo evaluate the clinical efficacy of neuroendoscope-assisted craniotomy with small bone window versus traditional drilling in the treatment of chronic subdural hematoma(CSDH) by meta-analysis. Methods Chinese and English databases, such as CNKI, Wanfang data, VIP, PubMed, EMbase and Cochrane Library, were searched by computer from establishment to November 2021. Clinical studies involving neuroendoscope-assisted small bone window craniotomy and traditional trepanation in the treatment of CSDH were selected for meta-analysis of data using RevMan 4.2 software. ResultsA total of 22 literatures were included, including 400 patients with delimited CSDH and 1 369 patients with CSDH. Meta-analysis results showed that the postoperative recurrence rate of neuroendoscopy-assisted small bone window craniotomy for the treatment of separated CSDH was lower than that of traditional trepanation(OR=0.17, 95%CI:0.08-0.35,P<0.000 01), and the postoperative complication rate was lower than that of traditional trepanation(OR=0.13, 95%CI:0.06-0.28,P<0.000 01). The postoperative recurrence rate of neuroendoscopy-assisted small bone window craniotomy for CSDH was lower than that of traditional drilling(OR=0.16, 95%CI:0.10-0.26,P<0.000 01), and the postoperative complication rate was lower than that of traditional drilling(OR=0.15, 95%CI:0.10-0.23,P<0.000 01). ConclusionsCompared with traditional drilling, neuroendoscope-assisted small bone window craniotomy for the treatment of separated CSDH and CSDH has the advantages of lower recurrence rate and fewer postoperative complications. Small bone window craniotomy assisted by neuroendoscopy should be the first choice for delimited CSDH. Conventional trepanation should be preferred for nondelimited CSDH.