组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (4): 380-.

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视神经减压术治疗外伤性视神经病变有效率的Meta 分析

  

  • 出版日期:2023-08-01 发布日期:2023-09-06

Effect of optic nerve decompression surgery in the treatment of traumatic optic neuropathy: A Meta-analysis

  • Online:2023-08-01 Published:2023-09-06

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摘要：

目的　系统评价视神经减压术（Optic nerve decompression，OND）治疗外伤性视神经病变（Traumatic optic neu
ropathy，TON）的有效率。方法　计算机检索 PubMed、EMbase、The Cochrane Library 和 Web of Science 等网站中，从建库
到 2023 年 2 月 7日的，关于 OND 治疗 TON 的回顾性研究。由两位研究人员按照纳入与排除标准对所获文献独立进行
筛选、提取，使用纽卡斯尔 - 渥太华量表（Newcastle-Ottawa Scale，NOS）评定所有纳入研究的质量。结局指标为视神
经减压术治疗外伤性视神经病的有效率，区间估计使用 95% 置信区间（Confidence interval，CI）表示，采用 Stata 16.0
软件对收集的数据进行 Meta 分析。结果　最终纳入 42 篇文献，共 3 579 例患者。Meta 分析结果显示，OND 治疗 TON
的总体有效率为 54.2%（95%CI 49.2%~59.2%）。以不同手术入路进行亚组分析，结果显示：经眶、神经内镜经鼻和经颅
入路治疗的有效率分别为 56.0%（95%CI 46.2%~65.7%）、52.8%（95%CI 45.1%~60.5%）和 50.0%（95%CI 36.1%~63.9%）。
伤后≤ 7 d 和 >7 d 手术减压有效率分别为 69.5%（95%CI 55.0%~82.5%）、28.6%（95%CI 21.4%~36.2%）；伤后 1~2 d
手术和 3~7 d 手术减压有效率分别为 71.5%（95%CI 45.2%~92.3%）、51.2%（95%CI 65.3%~100.0%）。术前有、无光
感患者的有效率分别为 79.2%（95%CI 84.6%~100.0%）、36.3%（95%CI 30.2%~42.6%）。切开视神经鞘联合 OND 的总
体有效率为 40.7%（95%CI 27.0%~55.1%）。结论　OND 是改善 TON 患者视力的有效方法，不同手术方式相差不大，经
眶手术减压有效率最高；手术时机应尽早，术前有光感患者预后较好，术中切开视神经鞘可能对患者的视力恢复有帮助。

关键词:

窦视神经减压

Abstract:

Objective　To systematically evaluate the efficacy of optic nerve decompression (OND) in the treatment of traumatic optic neuropathy (TON). Methods　A computer search was conducted for the retrospective studies on OND in the treatment of TON in PubMed, EMbase, The Cochrane Library and Web of Science from database establishment to February 7, 2023.
The obtained studies were independently screened and extracted by two researchers according to inclusion and exclusion criteria,
and their quality was assessed using the Newcastle-Ottawa Scale (NOS). The postoperative outcomes were considered to indicate
the efficiency of OND for TON. Interval estimates were expressed using a 95% confidence interval (CI), and the meta-analysis of
the collected data was performed using Stata 16.0 software. Results　A total of 42 studies, including 3,579 patients, were finally
included. The results of the meta-analysis were as follows: The overall efficiency of OND for TON was 54.2% (95% CI 49.2%-
59.2%). Subgroup analysis with different surgical approaches showed that the efficiency of endoscopic transorbital, transnasal,
and transcranial approaches for TON was 56.0% (95% CI 46.2%-65.7%), 52.8% (95% CI 45.1%-60.5%), and 50.0% (95%CI 36.1%-63.9%), respectively. The efficiency of OND ≤ 7 and >7 days post-injury was 69.5% (95% CI 55.0%-82.5%) and28.6% (95% CI 21.4%-36.2%), respectively, whereas 1-2 and 3-7 days post-injury, it was 71.5% (95% CI 45.2%-92.3%)and 51.2% (95% CI 65.3%-100.0%), respectively. The OND efficiency with and without light perception was 79.2% (95% CI 84.6%-100.0%) and 36.3% (95% CI 30.2%-42.6%), respectively. The overall efficiency of optic nerve sheath incision alongwith optic canal decompression was 40.7% (95% CI 27.0%-55.1%). Conclusion　OND is an effective method to improve vision in patients with TON. The difference in preoperative characteristics was not significant among different surgical methods. The transorbital approach showed the most favorable postoperative outcomes. The time of surgery should be as early as possible, and patients with preoperative light perception have a better prognosis. Also, intraoperative dissection of the optic nerve sheath may be helpful in vision restoration.

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