本文選題：小腦扁桃體下疝畸形I型　切入點(diǎn)：后顱窩減壓伴硬腦膜擴(kuò)大成形術(shù)　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:小腦扁桃體下疝畸形I型(CM-I)是一種常見的后顱窩先天性畸形,兒童和成人均可發(fā)病,常伴有脊髓空洞的發(fā)生。對于有明顯癥狀/體征的患者行后顱窩減壓伴硬腦膜成形術(shù)(posterior fossa decompression and duraplasty,PFDD)或硬腦膜外層切開減壓術(shù)(dural splitting decompression,DSD)均能明顯緩解臨床癥狀,但目前尚無關(guān)于以上兩種術(shù)式療效的大樣本、多中心的隨機(jī)對照試驗(yàn)。該Meta分析的目的是比較PFDD和DSD這兩種手術(shù)方式術(shù)后患者的癥狀/體征緩解、手術(shù)相關(guān)并發(fā)癥發(fā)生、脊髓空洞縮小、再手術(shù)率等。方法:通過計(jì)算機(jī)檢索2005.01.01-2015.12.31發(fā)表在Pub Med、EMBASE、Cochrane、萬方、中國知網(wǎng)等數(shù)據(jù)庫的文獻(xiàn)。由兩名研究者按照納入、排除標(biāo)準(zhǔn)對文獻(xiàn)進(jìn)行獨(dú)立篩選,并采用Newcastle-Ottawa量表對納入的文獻(xiàn)進(jìn)行質(zhì)量評價,然后提取數(shù)據(jù)用Rev Man 5.3軟件進(jìn)行數(shù)據(jù)分析。結(jié)果:最終納入5篇文獻(xiàn),共有230例,其中DSD組129例,PFDD組101例。對納入研究使用固定效應(yīng)模型Mantel-Haenszel法進(jìn)行Meta分析,結(jié)果顯示兩組患者術(shù)后癥狀/體征緩解率無明顯統(tǒng)計(jì)學(xué)差異[OR=0.69,95%CI(0.33,1.42),P=0.31];比較兩種術(shù)式術(shù)后脊髓空洞縮小情況無明顯統(tǒng)計(jì)學(xué)差異[OR=0.94,95%CI(0.29,3.11),P=0.92];而比較兩種術(shù)式的手術(shù)相關(guān)并發(fā)癥顯示DSD組并發(fā)癥發(fā)生率較PFDD組更低,且有統(tǒng)計(jì)學(xué)差異[OR=0.29,95%CI(0.09,0.91),P=0.03];兩種手術(shù)方式再手術(shù)率無明顯統(tǒng)計(jì)學(xué)差異[OR=0.53,95%CI(0.13,2.15),P=0.37]。結(jié)論:在治療CM-I型時,除DSD術(shù)后并發(fā)癥發(fā)生率較PFDD低之外,兩種手術(shù)方式在術(shù)后癥狀/體征緩解率、脊髓空洞縮小率、再手術(shù)率等結(jié)果指標(biāo)上無明顯差異。但是,由于受原始研究質(zhì)量、數(shù)量限制,以上結(jié)論尚需多中心、大樣本的隨機(jī)對照試驗(yàn)進(jìn)一步驗(yàn)證。
[Abstract]:Objective: type I subtonsillar hernia deformity (CM-I) is a common congenital malformation of posterior cranial fossa, which is common in children and adults. Syringomyelia is often associated with syringomyelia. For patients with obvious symptoms / signs, patients undergoing posterior fossa decompression and dura plastic surgery (PFDD) or dural splitting decompression with dural decompression can significantly relieve the clinical symptoms. However, there is no large sample of the results of the two operations, a multicenter randomized controlled trial. The purpose of this Meta analysis is to compare the symptoms / signs relief and complications associated with the operation between PFDD and DSD. Methods: from January to December 31, 2005.01.01-2015.12.31, 2005.01.01-2015.12.31, methods: the literatures published in Pub Medmassie Cochrane, Wanfang, China Zhiwang and other databases were searched by two researchers according to the inclusion and exclusion criteria. The quality of the included literature was evaluated with Newcastle-Ottawa scale, and the data was extracted and analyzed by Rev Man 5.3 software. Results: finally, 5 articles were included, a total of 230 cases were included. Among them, there were 129 cases in DSD group and 101 cases in PFDD group. The fixed effect model Mantel-Haenszel method was used to analyze Meta in the inclusion study. The results showed that there was no significant difference in the remission rate of symptoms / signs between the two groups [OR0.69 ~ 95CI0.331.42% P0. 31], and there was no significant difference in the reduction of syringomyelia between the two kinds of operation methods [OR0.9495CII 0.293.11P0.92], and the operative complications of the two operations showed DSD. The incidence of complications in group A was lower than that in group PFDD. There was no significant difference in the rate of reoperation between the two kinds of operation methods (OR0.5395). Conclusion: in the treatment of CM-I type, the incidence of postoperative complications of DSD is lower than that of PFDD, and the remission rate of symptoms / signs of the two kinds of operation methods is lower than that of PFDD. There was no significant difference in the reduction rate of syringomyelia and the rate of reoperation. However, due to the limitation of the quality and quantity of the original study, the above conclusions need to be further verified by a multicenter, large sample randomized controlled trial.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 呂學(xué)明;袁紹紀(jì);張榮偉;劉子生;陳援朝;呂福林;郁冰冰;彭兆輝;姜慶軍;李杰;;小腦扁桃體下疝的MR分型[J];中國微侵襲神經(jīng)外科雜志;2011年09期

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本文編號：1631573