腹腔镜辅助腹膜入路在脑室腹腔分流术中的应用:系统回顾与元分析》。

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Neurosurgery Pub Date : 2024-10-28 DOI:10.1227/neu.0000000000003213
Sunny Abdelmageed, Prottusha Sarkar, Nathan A Shlobin, Daniel G Davila, Matthew B Potts
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引用次数: 0

摘要

背景和目的:脑积水最常见的治疗方法是脑室腹腔分流术(VP)。腹膜入路通常通过开腹手术进行,但腹腔镜腹膜入路正越来越受欢迎。许多研究报告了微创腹腔镜腹膜入路的好处,但对其使用还没有达成共识。我们进行了一项系统性回顾和荟萃分析,比较开腹手术与腹腔镜腹膜入路在 VP 分流中的应用:方法:根据《系统综述和荟萃分析首选报告项目》指南,我们使用 3 个数据库进行了系统检索。12项研究仅包括成人患者,3项研究仅包括儿童患者,3项研究同时包括成人和儿童患者:结果:与开腹手术相比,腹腔镜腹膜入路可减少远端分流失败(6.1% vs 2.2%,P = .01)、手术时间(69.4 分钟 vs 56.3 分钟,P < .001)和住院时间(LOS)(9.6 天 vs 7.3 天,P < .001)。在近端分流失败、总分流失败、术中并发症或感染率方面没有差异。在儿童患者中,腹腔镜入路可缩短患者的住院时间(7.8 天 vs 5.9 天,P < .001)。异质性很高,但研究人群和技术的不同可以解释这一点:结论:与开腹手术相比,腹腔镜腹膜入路插入VP分流管可改善预后,包括减少分流管远端失败、缩短手术时间和缩短住院时间,因此应考虑将腹腔镜腹膜入路用于插入分流管。有必要进行更多研究,以进一步确定腹腔镜入路的益处,尤其是在儿科人群中。
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Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis.

Background and objectives: The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting.

Methods: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients.

Results: Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques.

Conclusion: Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.

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来源期刊
Neurosurgery
Neurosurgery 医学-临床神经学
CiteScore
8.20
自引率
6.20%
发文量
898
审稿时长
2-4 weeks
期刊介绍: Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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