显微血管减压术治疗舌咽神经痛有效性和安全性的Meta分析

摘要

Objective To investigate the efficacy and safety of the microvascular decompression (MVD) for glossopharyngeal neuralgia (GN).Methods A systematic review was performed to retrieve relevant literatures up to February 2018 through PubMed,Embase and Web of Science database.The relevant literatures were screened according to the inclusion and exclusion criteria.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to conduct a quality evaluation for the included literatures.The relevant data were extracted to evaluate the immediate complete remission rate post operation,long-term remission,proportion of occurrence on the left side,proportion of posterior inferior cerebellar artery (PICA) as offending vessel,proportion of a single vessel as offending vessel,operational mortality and complications.Meta-analysis was conducted by using the meta package of R software.Results A total of 12 studies involving 665 patients were enrolled.The mean STROBE score of the included literatures was 16.The immediate complete remission after operation was achieved in 553 of 665 patients and the corresponding rate was 91％ (95％ CI:83％-96％,I2 =82％).The long-term remission was achieved in 298 of 335 patients and the corresponding rate was 87％ (95％ CI:80％-93％,I2 =64％).The symptoms of 387 in 665 patients were located on the left and the proportion of occurrence on the left side was 59％ (95％ CI:52％-67％,I2 =67％).The PICA was found to be the offending vessel in 292 of 408 patients and the corresponding proportion was 72％ (95％ CI:68％-76％,I2 =0).A single vessel was found to be the offending vessel in 336 of 408 patients and the corresponding proportion was 84％ (95％ CI:77％-93％,I2 =82％).The funnel plot and Egger linear regression demonstrated no publication bias.The cumulative meta-analysis suggested that the rate of remission did not change with a fixed trend with the date of the publication.Sensitivity analysis and subgroup analysis provided similar results.Conclusions The results of our meta-analysis suggested that MVD is an effective and safe modality of treatment for GN with high immediate postoperative complete remission rate,high long-term complete remission rate and low relapse rate.The surgical complications of MVD are few and slight,which is worth getting promoted.%目的 通过Meta分析评价显微血管减压术(MVD)治疗舌咽神经痛的有效性和安全性.方法 检索PubMed、Embase以及Web of Science数据库中有关MVD治疗舌咽神经痛的文献,时间为建库至2018年2月.根据纳入标准和排除标准筛选文献.采用观察性流行病学研究报告规范的文献质量评价标准进行文献评价.提取数据资料,采用R软件的Meta程序包进行统计学分析,以评估术后早期完全缓解率、长期完全缓解率、症状位于左侧者所占的比例、责任血管为小脑后下动脉(PICA)者所占的比例、责任血管为单根血管者所占的比例、手术死亡以及并发症的发生情况.结果 共纳入12篇文献,包括665例患者.纳入文献质量的中位评分为16分.665例MVD患者中,553例达到早期完全缓解,早期完全缓解率为91％ (95％ CI:83％ ～96％,I2=82％).335例患者获得长期随访,其中298例达到长期完全缓解,长期完全缓解率为87％ (95％ CI:80％ ～ 93％,I2=64％).665例患者中,症状位于左侧者387例,所占比例为59％ (95％ CI:52％～67％,I2=67％).责任血管明确的408例患者中,责任血管为PICA者共292例,所占比例为72％(95％ CI:68％～76％,I2=0).责任血管为单根血管的患者共336例,所占比例为84％ (95％ CI:77％～93％,I2=82％).漏斗图和Egger线性回归结果提示无发表偏倚.累积Meta分析结果提示,早期缓解率和长期缓解率不随文献的发表年份呈固定趋势变化.敏感性分析和亚组分析提供了相似的结果.结论 MVD对舌咽神经痛的治疗效果好,术后早期和长期完全缓解率高,复发率低,手术并发症少且轻微,值得推广.