可調壓分流管置入治療腦積水療效的系統評價_《中國循證醫學雜志》

作者：

徐昊 ,  王占祥 , 陳東漢 , 張紹林 , 郭劍鋒 , 譚國偉 , 陳四方 , 朱宏偉

廈門大學附屬第一醫院神經外科（廈門 361022）;

關鍵詞：

腦積水腦室腹腔分流術可調壓分流管常規非可調壓分流管系統評價 Meta分析

DOI：

10.7507/1672-2531.20130015

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價可調壓分流管置入治療腦積水的療效和安全性。
方法　計算機檢索PubMed、Cochrane 圖書館、EMbase、CNKI、CBM、VIP和WanFang Data，收集可調壓分流管與常規非可調壓分流管置入比較治療腦積水的隨機對照試驗或非隨機的同期對照試驗，檢索時限從1992年1月至2012年1月。由2名研究者按照納入標準獨立篩選文獻、提取資料、評價質量并交叉核對后，采用RevMan5.0軟件進行Meta分析。
結果　納入11個非隨機的同期對照試驗，共1 485例患者。Meta分析結果顯示：可調壓分流管在總體有效率［RR=1.14，95%CI（1.03，1.27），P=0.01］、2年生存率［RR=1.25，95%CI（1.04，1.51），P=0.02］、二次手術換管率［RR=0.53，95%CI（0.39，0.73），P lt;0.001］、總并發癥發生率［RR=0.62，95%CI（0.51，0.76），P lt;0.001］和分流過度或不足發生率［RR=0.42，95%CI（0.21，0.83），P=0.01］方面均優于常規非可調壓分流管，其差異有統計學意義；但在1年生存率［RR=1.04，95%CI（0.91，1.19），P=0.55］、術后感染率［RR=1.08，95%CI（0.73，1.60），P=0.71］和分流管相關并發癥［RR=0.80，95%CI（0.56，1.21），P=0.20］方面，兩組差異無統計學意義。
結論　現有證據提示可調壓分流管在增加分流有效率、減少分流并發癥和延長患者遠期生存率方面存在優勢。受納入研究數量和質量限制，還需要開展更多高質量的多中心隨機雙盲對照試驗進一步驗證其能否作為分流手術首選在臨床推廣。

引用本文： 徐昊,王占祥,陳東漢,張紹林,郭劍鋒,譚國偉,陳四方,朱宏偉. 可調壓分流管置入治療腦積水療效的系統評價. 中國循證醫學雜志, 2013, 13(1): 78-85. doi: 10.7507/1672-2531.20130015 復制

1.	Nulsen FE, Becker DP. Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum, 1952, 2(1): 399-403.
2.	Black PM, Hakim R, Olson BN. The use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery, 1994, 34(21): 1110-1113.
3.	Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27): 170-173.
4.	McGirt MJ, Buck DW 2nd, Sciubba D, et al. Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus. Childs Nerv Syst, 2007, 23(3): 289-295.
5.	Ringel F, Schramm J, Meyer B. Comparison of programmable shunt valves vs standard valves for communicating hydrocephalus of adults: a retrospective analysis of 407 patients. Surg Neurol, 2005, 63(1): 36-41.
6.	Mpakopoulou M, Brotis AG, Gatos H, et al. Ten years of clinical experience in the use of fixed-pressure versus programmable valves: a retrospective study of 159 patients. Acta Neurochir Suppl, 2012, 113(65): 25-28.
7.	Lee WC, Seo DH, Choe IS, et al. A comparative result of ventriculoperitoneal shunt, focusing mainly on gravity-assisted valve and programmable valve. J Korean Neurosurg Soc, 2010, 48(3): 251-258.
8.	Zemack G, Romner B. Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery, 2008, 62(2): 677-687.
9.	單臻, 陳昆, 黃育嬋, 等. 可調壓與常規非可調壓分流管治療兒童交通性腦積水療效的比較. 中華神經醫學雜志, 2011, 16(3): 299-302.
10.	李志勇, 漆松濤, 方陸雄, 等. 可調壓式分流管治療腦積水(附30例報告). 中華神經外科雜志, 2007, 10(10): 748-749.
11.	趙希敏, 劉勇, 劉霞. 正常壓力腦積水的臨床特征和手術治療. 中國臨床神經外科雜志, 2011, 16(9): 538-540.
12.	吳雷, 鄧志鋒, 劉越, 等. 使用可調壓分流管治療腦積水39例分析. 實用醫學雜志, 2011, 27(18): 3385-3387.
13.	柏魯寧, 張毅, 侯文, 等. 可調壓式分流管治療腦積水的臨床觀察. 山西醫科大學學報, 2011, 42(3): 249-251.
14.	周煜. 可調壓式腦室-腹腔分流管治療外傷性腦積水臨床研究. 山東醫藥, 2010, 50(4): 53-54.
15.	Zemack G, Romner B. Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg, 2000, 92(6): 941-948.
16.	Czosnyka Z, Czosnyka M, Copeman J, et al. A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Neurosurgery, 1999, 45(6): 1399-1408.
17.	Hertel F, Züchner M, Decker C, et al. The Miethke dual switch valve: experience in 169 adult patients with different kinds of hydrocephalus: an open field study. Minim Invasive Neurosurg, 2008, 51(3): 147-153.
18.	Reinprecht A, Dietrich W, Bertalanffy A, et al. The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus.Childs Nerv Syst, 1997, 13(11-12): 588-593.
19.	Yamashita N, Kamiya K, Yamada K. Experience with a programmable valve shunt system. J Neurosurg, 1999, 91(1): 26-31.
20.	王小平, 郭爾安, 齊巍, 等. 使用可調壓分流管行腦室一腹腔分流術治療小兒腦積水. 中華神經外科雜志, 2008, 24(11): 857-859.
21.	Allin DM, Czosnyka ZH, Czosnyka M, et al. In vitro hydrodynamic properties of the Miethke ProGAV hydrocephalus shunt. Cerebrospinal Fluid Res, 2006, 29(3): 9.
22.	Zachenhofer I, Donat M, Roessler K. The combination of a programmable valve and a subclavicular anti-gravity device in hydrocephalus patients at high risk for hygromas. Neurol Res, 2012, 34(3): 219-222.

1. Nulsen FE, Becker DP. Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum, 1952, 2(1): 399-403.
2. Black PM, Hakim R, Olson BN. The use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery, 1994, 34(21): 1110-1113.
3. Deeks JJ, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess, 2003, 7(27): 170-173.
4. McGirt MJ, Buck DW 2nd, Sciubba D, et al. Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus. Childs Nerv Syst, 2007, 23(3): 289-295.
5. Ringel F, Schramm J, Meyer B. Comparison of programmable shunt valves vs standard valves for communicating hydrocephalus of adults: a retrospective analysis of 407 patients. Surg Neurol, 2005, 63(1): 36-41.
6. Mpakopoulou M, Brotis AG, Gatos H, et al. Ten years of clinical experience in the use of fixed-pressure versus programmable valves: a retrospective study of 159 patients. Acta Neurochir Suppl, 2012, 113(65): 25-28.
7. Lee WC, Seo DH, Choe IS, et al. A comparative result of ventriculoperitoneal shunt, focusing mainly on gravity-assisted valve and programmable valve. J Korean Neurosurg Soc, 2010, 48(3): 251-258.
8. Zemack G, Romner B. Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery, 2008, 62(2): 677-687.
9. 單臻, 陳昆, 黃育嬋, 等. 可調壓與常規非可調壓分流管治療兒童交通性腦積水療效的比較. 中華神經醫學雜志, 2011, 16(3): 299-302.
10. 李志勇, 漆松濤, 方陸雄, 等. 可調壓式分流管治療腦積水(附30例報告). 中華神經外科雜志, 2007, 10(10): 748-749.
11. 趙希敏, 劉勇, 劉霞. 正常壓力腦積水的臨床特征和手術治療. 中國臨床神經外科雜志, 2011, 16(9): 538-540.
12. 吳雷, 鄧志鋒, 劉越, 等. 使用可調壓分流管治療腦積水39例分析. 實用醫學雜志, 2011, 27(18): 3385-3387.
13. 柏魯寧, 張毅, 侯文, 等. 可調壓式分流管治療腦積水的臨床觀察. 山西醫科大學學報, 2011, 42(3): 249-251.
14. 周煜. 可調壓式腦室-腹腔分流管治療外傷性腦積水臨床研究. 山東醫藥, 2010, 50(4): 53-54.
15. Zemack G, Romner B. Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg, 2000, 92(6): 941-948.
16. Czosnyka Z, Czosnyka M, Copeman J, et al. A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Neurosurgery, 1999, 45(6): 1399-1408.
17. Hertel F, Züchner M, Decker C, et al. The Miethke dual switch valve: experience in 169 adult patients with different kinds of hydrocephalus: an open field study. Minim Invasive Neurosurg, 2008, 51(3): 147-153.
18. Reinprecht A, Dietrich W, Bertalanffy A, et al. The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus.Childs Nerv Syst, 1997, 13(11-12): 588-593.
19. Yamashita N, Kamiya K, Yamada K. Experience with a programmable valve shunt system. J Neurosurg, 1999, 91(1): 26-31.
20. 王小平, 郭爾安, 齊巍, 等. 使用可調壓分流管行腦室一腹腔分流術治療小兒腦積水. 中華神經外科雜志, 2008, 24(11): 857-859.
21. Allin DM, Czosnyka ZH, Czosnyka M, et al. In vitro hydrodynamic properties of the Miethke ProGAV hydrocephalus shunt. Cerebrospinal Fluid Res, 2006, 29(3): 9.
22. Zachenhofer I, Donat M, Roessler K. The combination of a programmable valve and a subclavicular anti-gravity device in hydrocephalus patients at high risk for hygromas. Neurol Res, 2012, 34(3): 219-222.

上一篇
認知行為療法對乳腺癌患者失眠治療效果的系統評價
下一篇
補充維生素D對血壓影響的系統評價

《中國循證醫學雜志》

可調壓分流管置入治療腦積水療效的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國循證醫學雜志》

可調壓分流管置入治療腦積水療效的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料