可调压分流管置入治疗脑积水疗效的系统评价_《中国循证医学杂志》

作者：

徐昊 ,  王占祥 , 陈东汉 , 张绍林 , 郭剑锋 , 谭国伟 , 陈四方 , 朱宏伟

厦门大学附属第一医院神经外科（厦门 361022）;

关键词：

脑积水脑室腹腔分流术可调压分流管常规非可调压分流管系统评价 Meta分析

DOI：

10.7507/1672-2531.20130015

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价可调压分流管置入治疗脑积水的疗效和安全性。
方法　计算机检索PubMed、Cochrane 图书馆、EMbase、CNKI、CBM、VIP和WanFang Data，收集可调压分流管与常规非可调压分流管置入比较治疗脑积水的随机对照试验或非随机的同期对照试验，检索时限从1992年1月至2012年1月。由2名研究者按照纳入标准独立筛选文献、提取资料、评价质量并交叉核对后，采用RevMan5.0软件进行Meta分析。
结果　纳入11个非随机的同期对照试验，共1 485例患者。Meta分析结果显示：可调压分流管在总体有效率［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］、二次手术换管率［RR=0.53，95%CI（0.39，0.73），P lt;0.001］、总并发症发生率［RR=0.62，95%CI（0.51，0.76），P lt;0.001］和分流过度或不足发生率［RR=0.42，95%CI（0.21，0.83），P=0.01］方面均优于常规非可调压分流管，其差异有统计学意义；但在1年生存率［RR=1.04，95%CI（0.91，1.19），P=0.55］、术后感染率［RR=1.08，95%CI（0.73，1.60），P=0.71］和分流管相关并发症［RR=0.80，95%CI（0.56，1.21），P=0.20］方面，两组差异无统计学意义。
结论　现有证据提示可调压分流管在增加分流有效率、减少分流并发症和延长患者远期生存率方面存在优势。受纳入研究数量和质量限制，还需要开展更多高质量的多中心随机双盲对照试验进一步验证其能否作为分流手术首选在临床推广。

引用本文： 徐昊,王占祥,陈东汉,张绍林,郭剑锋,谭国伟,陈四方,朱宏伟. 可调压分流管置入治疗脑积水疗效的系统评价. 中国循证医学杂志, 2013, 13(1): 78-85. doi: 10.7507/1672-2531.20130015 复制

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.	单臻, 陈昆, 黄育婵, 等. 可调压与常规非可调压分流管治疗儿童交通性脑积水疗效的比较. 中华神经医学杂志, 2011, 16(3): 299-302.
10.	李志勇, 漆松涛, 方陆雄, 等. 可调压式分流管治疗脑积水(附30例报告). 中华神经外科杂志, 2007, 10(10): 748-749.
11.	赵希敏, 刘勇, 刘霞. 正常压力脑积水的临床特征和手术治疗. 中国临床神经外科杂志, 2011, 16(9): 538-540.
12.	吴雷, 邓志锋, 刘越, 等. 使用可调压分流管治疗脑积水39例分析. 实用医学杂志, 2011, 27(18): 3385-3387.
13.	柏鲁宁, 张毅, 侯文, 等. 可调压式分流管治疗脑积水的临床观察. 山西医科大学学报, 2011, 42(3): 249-251.
14.	周煜. 可调压式脑室-腹腔分流管治疗外伤性脑积水临床研究. 山东医药, 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, 郭尔安, 齐巍, 等. 使用可调压分流管行脑室一腹腔分流术治疗小儿脑积水. 中华神经外科杂志, 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. 单臻, 陈昆, 黄育婵, 等. 可调压与常规非可调压分流管治疗儿童交通性脑积水疗效的比较. 中华神经医学杂志, 2011, 16(3): 299-302.
10. 李志勇, 漆松涛, 方陆雄, 等. 可调压式分流管治疗脑积水(附30例报告). 中华神经外科杂志, 2007, 10(10): 748-749.
11. 赵希敏, 刘勇, 刘霞. 正常压力脑积水的临床特征和手术治疗. 中国临床神经外科杂志, 2011, 16(9): 538-540.
12. 吴雷, 邓志锋, 刘越, 等. 使用可调压分流管治疗脑积水39例分析. 实用医学杂志, 2011, 27(18): 3385-3387.
13. 柏鲁宁, 张毅, 侯文, 等. 可调压式分流管治疗脑积水的临床观察. 山西医科大学学报, 2011, 42(3): 249-251.
14. 周煜. 可调压式脑室-腹腔分流管治疗外伤性脑积水临床研究. 山东医药, 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, 郭尔安, 齐巍, 等. 使用可调压分流管行脑室一腹腔分流术治疗小儿脑积水. 中华神经外科杂志, 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.

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《中国循证医学杂志》

可调压分流管置入治疗脑积水疗效的系统评价

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《中国循证医学杂志》

可调压分流管置入治疗脑积水疗效的系统评价

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