小剂量荧光素钠引导脑胶质瘤切除术临床效果的Meta分析

Meta-Analysis of Clinical Effect of Low-Dose Sodium Fluorescein Guided Resection of Brain Glioma

摘要: 目的：使用Cochrance官网的RevMan 5.4软件对小剂量荧光素钠注射液引导脑胶质瘤切除术的临床效果进行系统评价。方法：通过对Pubmed、GeenMedical、CNKI、google学术、万方等数据库进行检索，收集文献内容为术中使用荧光素钠引导显微镜对脑胶质瘤进行切除的文献，检索时限为从建库至2022年10月为止。对收集的文献按照荧光素钠使用剂量等标准进行筛选，对符合标准的文献进行数据统计后使用RevMan 5.4软件进行Meta分析。结果：此Meta分析共包含16篇队列研究，包括1338例患者，其中观察组623例，对照组715例。观察组患者采用术中静脉注射小剂量荧光素钠引导显微镜进行肿瘤切除，对照组采用术中使用常规显微镜进行肿瘤切除。结果：Meta分析显示，观察组患者在肿瘤全切除率[95% CI (2.67~4.52), OR = 3.48, P < 0.00001]、术后1个月KPS评分[95% CI (1.67~5.92), OR = 3.15, P = 0.0004]、术后并发症(颅内感染、颅内血肿、脑积水等)发生率[95% CI (0.25~0.61), OR = 0.39, P < 0.0001]的差异具有统计学意义，而术后3个月肿瘤复发率[95% CI (0.10~1.31), OR = 0.36, P = 0.12]、术中出血量[95% CI (−208.73~51.35), MD = −78.69, P = 0.24]、手术时间[95% CI (−18.49~1.01), MD = −8.74, P = 0.08]的差异不具有统计学意义。结论：相对于传统显微手术，在脑胶质瘤切除过程中使用小剂量荧光素钠仍能显著提高肿瘤全切除率，提高患者术后生存质量，减少术后并发症的发生。

Abstract: Objective: To systematically evaluate the clinical effect of glioma resection guided by low-dose fluo-rescein sodium injection by using RevMan 5.4 software of Cochrance official website. Methods: By searching Pubmed, GeenMedical, CNKI, google and Wanfang databases, the literature content was collected for glioma resection with fluorescein sodium guided microscope during operation, and the search time was from the establishment of the database to October 2022. The collected literatures were screened according to the standards such as the dosage of fluorescein sodium, and the data of the literatures meeting the standards were counted and meta-analyzed by RevMan 5.4 software. Results: This meta-analysis consisted of 16 cohort studies, including 1338 patients, including 623 patients in the observation group and 715 patients in the control group. Patients in the observation group underwent tumor resection by intravenous injection of small dose of fluorescein sodium guided microscope during operation, while those in the control group underwent tumor resection by conventional microscope during operation. Results: Meta-analysis showed that the total resec-tion rate [95% CI (2.67~4.52), OR = 3.48, P < 0.00001], KPS score 1 month postoperatively [95% CI (1.67~5.92), OR = 3.15, P = 0.0004], incidence of postoperative complications (intracranial infection, intracranial hematoma, hydrocephalus, etc.) [95% CI (0.25~0.61), OR = 0.39, P < 0.0001], Tumor recurrence rate 3 months after surgery [95% CI (0.10~1.31), OR = 0.36, P = 0.12], intraoperative hemorrhage [95% CI (−208.73~51.35), MD = −78.69, P = 0.24], and operative time [95% CI (−18.49~1.01), MD = −8.74, P = 0.08]. The difference was not statistically significant. Conclusion: Compared with the traditional microsurgery, the intraoperative use of low-dose fluorescein sodium guided microscope for glioma resection can significantly improve the total resection rate, improve the quality of life of patients after operation, and reduce the occurrence of postoperative complica-tions.