微血管减压术预后与并发症的危险因素——Meta分析

Risk Factors for Prognosis and Complications after Microvascular Decompression—A Meta Analysis

摘要: 目的：通过系统评估微血管减压术(Microvascular Decompression, MVD)的预后和并发症的危险因子，为改善MVD手术预后及并发症提供预防的依据。方法：计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、The Cochrane Library、PubMed、EMbase等数据库，文献检索的发表时间为2015年1月1日至2021年1月1日，检索语为“微血管减压术”、“logitic”、“并发症”、“危险因素”和相关自由词。文献检索的研究类型是病例对照研究和队列研究。全面收集相关案例，根据纳入标准和排除标准进行筛选，用纽卡斯尔–渥太华(NOS)文献质量评价表对选定的文献进行质量评价，评分≥ 7 (高质量)的文献，用RevMan5.3作为处理软件进行Meta分析。结果：19篇文献符合纳入基准，累计病例数和对照数分别为770例和2604例，Meta分析的结果如下。MVD手术预后的危险因子包括：责任血管包括基底动脉(OR = 8.08, 95% CI: 3.27~19.98)、无血管神经压迹(OR = 2.84, 95% CI: 1.79~4.52)、非典型临床表现(OR = 7.42, 95% CI: 4.29~12.83)。MVD术后并发症的危险因素是，责任血管通过神经根通过血管从神经根进入脑干(OR = 2.75, 95% CI: 1.87~4.05)，骨窗前缘到颞骨岩部内侧面的距离 > 2 cm (OR = 2.93, 95% CI: 1.91~4.52)，手术时间 >4 h (OR = 2.55 95% CI: 1.93~3.37)。结论：责任血管包括椎基底动脉、无血管神经压迹、非典型的临床表现是MVD手术预后相关的独立危险因子，患者有上述危险因子的情况下，术后症状的缓解率相对降低。责任血管发出穿支血管包绕神经根出/入脑干区(REZ)，骨窗前缘至颞骨岩部内侧面的距离2 cm、手术时间 > 4 h是MVD术后并发症的独立危险因素，患者在有上述危险因素时，术后并发症的发生率变高。对这些危险因素的处理有助于提高患者MVD手术的成功率并降低术后并发症的发生风险。

Abstract: Objective: To explore the risk factors of prognosis and complications after microvascular decompression by means of systematic evaluation, and provide evidence for the prevention complications after microvascular decompression. Methods: CNKI, CBM, Wanfang Database, the Cochrane Library, PubMed Database, EBSCO Full-text Database and other databases were searched by computer. The publication time of the literature search was from January 1, 2015 to January 1, 2021. The search terms were “microvascular decompression”, “logistic”, “complications”, “risk factors” and related free words. The research types of literature retrieval are case-control study and cohort study. Comprehensively collect relevant cases, screen them according to the inclusion criteria and exclusion criteria, and evaluate the quality of the selected documents with the Newcastle-Ottawa Scale. For the documents with a score ≥ 7 (high quality), RevMan5.3 perform meta-analysis as processing software. Result: A total of 19 articles were included in the meta-analysis with the cumulative number of cases and controls reaching 770 and 2604 respectively. Meta-analysis showed that the risk factors for prognosis after microvascular decompression are vertebrobasilar artery as offending vessel (OR = 8.08, 95% CI: 3.27~19.98), morphologic changes on the nerve (OR = 2.84, 95% CI: 1.79~4.52), atypical cases (OR = 7.42, 95% CI: 4.29~12.83). Meta-analysis showed that the risk factors for complications after microvascular decompression are perforating arteries adjacent to REZ (OR = 2.75, 95% CI: 1.87~4.05), distance from the anterior edge of bone window to the interior wall of petrousal bone over 2 cm (OR = 2.93, 95% CI: 1.91~4.52), operation time > 4 h (OR = 2.55, 95% CI: 1.93~3.37). Conclusion: Vertebrobasilar artery as offending vessel, morphologic changes on the nerve, atypical cases, are independent risk factors for prognosis of microvascular decompression, perforating arteries adjacent to REZ, distance from the anterior edge of bone window to the interior wall of petrous bone over 2 cm and operation time > 4 h are independent risk factors for complications of microvascular decompression. These risk factors can guide the choice of surgical procedures, evaluate the risk of complications, improve the prognosis of patients and reduce the incidence of complications.