腰大池-腹腔分流术与脑室-腹腔分流术治疗交通性脑积水疗效的系统评价

目的系统评价腰大池-腹腔分流术与脑室-腹腔分流术治疗交通性脑积水的疗效和安全性。方法计算机检索Pub Med、Cochrane图书馆、EMbase、CNKI、Wan Fang Data、CBM及VIP数据库,检索时限自1990年5月至2016年5月,收集关于LPS与VPS比较治疗交通性脑积水的随机对照试验或队列研究,利用Rev Man 5.3软件进行Meta分析。结果最终纳入13篇文献,共计1321例患者。Meta分析结果显示,在手术疗效方面,LPS组与VPS组治疗交通性脑积水的手术有效率之间无明显的统计学差异,但LPS手术一次成功率高于VPS;在并发症方面,LPS的术后出血并发症、感染性并发症、分流管相关并发症及术后癫痫的发生率更低,两种术式术后出现分流异常的发生率无明显统计学差异。结论 LPS与VPS治疗交通性脑积水的疗效相当,但LPS一次手术成功率更高,术后并发症的发生率更低,整体而言,LPS优于VPS。

Efficacy of lumbo-peritoneal shunt versus ventriculo-peritoneal shunt for treatment of communicating hydrocephalus: a systematic review

Objective To systematically evaluate the efficacy and safety of lumbo-peritoneal shunt (LPS) and ventriculo-peritoneal shunt (VPS) for the treatment of communicating hydrocephalus.Methods Databases such as PubMed, Cochrane Library, EMbase, CNKI, WanFang Data, CBM and VIP were searched to collect randomized controlled trials or cohort studies on LPS versus VPS for the treatment of communicating hydrocephalus that were published from May 1990 to May 2016. A meta-analysis was conducted using RevMan 5.3 software.Results Thirteen articles were included in the study, with a total of 1321 patients. The meta-analysis showed that there was no significant difference between the LPS group and the VPS group in the effectiveness of the surgical treatment of communicating hydrocephalusRR=1.13, 95%CI (1.00, 1.28), P=0.06]. However, the success rate of LPS was significantly higher than that of VPSRR=1.14, 95%CI (1.05, 1.23), P=0.0010]. Compared with those treated with VPS, the patients treated with LPS had significantly lower incidence rates of postoperative bleeding complicationsRR=0.35, 95%CI (0.15, 0.81), P=0.01], infectious complicationsRR=0.29, 95% CI (0.16, 0.51), P<0.0001], and shunt tube-related complicationsRR=0.38, 95%CI (0.27, 0.52), P<0.00001]. The incidence of postoperative shunt abnormalities showed no significant difference between the two operationsRR=0.79, 95%CI(0.41, 1.53), P=0.49].Conclusions The results of this study suggest that LPS and VPS are equivalent in the treatment of communicating hydrocephalus. However, the success rate of LPS is higher, and the incidence of postoperative complications is lower after LPS. Overall, LPS is superior to VPS.