术前辅助栓塞联合手术治疗脑膜瘤的Meta分析

目的使用Meta分析方法评价术前栓塞联合手术治疗脑膜瘤的临床疗效及安全性。方法计算机检索medline、sciencedirect、springer、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库,并辅手工和其他检索,纳入国内外比较术前辅助栓塞联合手术治疗与单纯手术治疗脑膜瘤的随机或非随机对照试验,由2名评价员独立选择文献、提取资料并交叉核对,并对其方法学质量进行评价,采用RevM an 5.2软件进行统计分析。结果总计有12篇文献纳入Meta分析(725例患者)。Meta分析结果显示脑膜瘤术前辅助栓塞联合手术组和单纯手术组在全切率、出血量、输血量、术后恢复时间方面,差异有统计学意义OR=4.08,95%CI(2.45,6.77);WMD=-203.50,95%CI(-251.53,-155.47;WMD=-282.41,95%CI(-372.71,-192.10),P0.00001;WMD=-4.38,95%CI(-5.69,-3.07),P0.00001],但在手术时间方面无统计学意义WMD=-0.39,95%CI(-1.72,0.94),P=0.56]。虽然漏斗图形右侧底部出现缺失,但Begg法及Egger法检测均提示研究中不存在明显的偏倚。结论证明了脑膜瘤的术前栓塞有利于提高肿瘤的全切率,减少术中出血、输血,并且缩短恢复时间。

Meta-analysis of treating meningiomas by surgery combined with preoperative endovascular embolization

Objective To evaluate the clinical efficacy and safety of presurgical embolization of meningiomas.Methods The data bases including MEDLINE,sciencedirect,springer,CBM,CNKI and VIP were searched for the related trails.Two independent reviewers assessed trials for eligibility and quality,and all the related data matching our standards were abstracted for Meta-analysis by RevMan 5.2.Results 12 randomized controlled trails were included.Matched analysis of samples of embolized and nonembolized groups of meningiomas were observed for variables of clinical efficacy in estimated blood loss,number of transfusions and length of post-operative recovery,there were statistical difference.OR =4.08,95% CI （2.45,6.77） ; WMD =-203.50,95% CI （-251.53,-155.47;WMD =-282.41,95% CI （-372.71,-192.10）,P 〈 0.00001;WMD =-4.38,95% CI （-5.69,-3.07）,P 〈0.00001],But no statistical difference between surgery timeWMD =-0.39,95%CI（-1.72,0.94）,P =0.56].The graphical funnel plot appearing the missing point appear on right side.But Begg and Egger assay had prompted the study there was no obvious bias.Conclusion The preoperation endovascular embolization of meningiomas is beneficial for meningiomas because it raises the rate of total resection,diminishes the necessity of intra operative transfusion and blood loss.It also fasten the operative recovery.