CAJ | 학술논문

目的：系统评价经皮椎间孔镜椎间盘切除术( percutaneous transforaminal endoscopic discectomy, PTED)与显微内镜椎间盘切除术( microendoscopic discectomy, MED)治疗腰椎间盘突出症的效果及安全性。方法计算机检索建库至2014年9月Cochrane Library、PubMed、Medline、Ovid、SpringerLink、中国生物医学文献数据库、中国知网、维普和万方数据库文献,同时辅以手工检索,收集关于PTED和MED治疗腰椎间盘突出症的随机对照试验。根据纳入与排除标准独立进行文献筛选、质量评价和资料提取后,应用Revman 5.2软件对结局指标进行meta分析。结果最终纳入4篇文献650例,其中PTED组327例,MED组323例。 meta分析结果显示,与MED组比较,PTED组术中失血量少(MD=-39.49,95%CI-64.65~-14.32,Z =3.08,P=0．002)、切口小( MD=-10.25,95%CI -13.02~-7.48, Z=7.25,P<0．00001)、术后卧床时间短( MD=-55.42,95%CI -66.05~-44.80,Z=10.22,P<0．00001)、住院时间短( MD=-3.95,95%CI -5.27~-2.63,Z=5.87,P<0．00001),差异有统计学意义；但平均手术时间(MD=17．30,95%CI -4.03~38.64,Z=1.59,P=0.11)、术后视觉模拟评分法评分(MD=-0.03,95%CI -0.26~0.21, Z=0.22,P=0.83)、术后功能障碍指数改善率(MD=2.38,95%CI -0.93~5.70,Z=1.41,P=0.16)及并发症发生率(OR=1.36,95%CI 0.46~4.04,Z=0.55,P=0.58)两组比较差异无统计学意义。结论 PTED与MED治疗腰椎间盘突出症相比,效果及安全性相当,但前者更具有微创优势。但因受限于纳入研究的数量和质量,上述结论仍需更多高质量长期随访的随机对照试验进一步验证。
목적：계통평개경피추간공경추간반절제술( percutaneous transforaminal endoscopic discectomy, PTED)여현미내경추간반절제술( microendoscopic discectomy, MED)치료요추간반돌출증적효과급안전성。방법계산궤검색건고지2014년9월Cochrane Library、PubMed、Medline、Ovid、SpringerLink、중국생물의학문헌수거고、중국지망、유보화만방수거고문헌,동시보이수공검색,수집관우PTED화MED치료요추간반돌출증적수궤대조시험。근거납입여배제표준독립진행문헌사선、질량평개화자료제취후,응용Revman 5.2연건대결국지표진행meta분석。결과최종납입4편문헌650례,기중PTED조327례,MED조323례。 meta분석결과현시,여MED조비교,PTED조술중실혈량소(MD=-39.49,95%CI-64.65~-14.32,Z =3.08,P=0．002)、절구소( MD=-10.25,95%CI -13.02~-7.48, Z=7.25,P<0．00001)、술후와상시간단( MD=-55.42,95%CI -66.05~-44.80,Z=10.22,P<0．00001)、주원시간단( MD=-3.95,95%CI -5.27~-2.63,Z=5.87,P<0．00001),차이유통계학의의；단평균수술시간(MD=17．30,95%CI -4.03~38.64,Z=1.59,P=0.11)、술후시각모의평분법평분(MD=-0.03,95%CI -0.26~0.21, Z=0.22,P=0.83)、술후공능장애지수개선솔(MD=2.38,95%CI -0.93~5.70,Z=1.41,P=0.16)급병발증발생솔(OR=1.36,95%CI 0.46~4.04,Z=0.55,P=0.58)량조비교차이무통계학의의。결론 PTED여MED치료요추간반돌출증상비,효과급안전성상당,단전자경구유미창우세。단인수한우납입연구적수량화질량,상술결론잉수경다고질량장기수방적수궤대조시험진일보험증。
Objective To systematically compare and evaluate the safety and effectiveness between percutaneous transforaminal endoscopic lumbar discectomy and microendoscopic discectomy in treatment of lumbar disc herniation. Methods Cochrane Library, PubMed, Medline, Ovid, SpringerLink, the China Biological Medicine Database, CNKI, VIP and Wan-fang Database were searched for articles published from the building of data base up to September 2014. Related journals were retrieved by hand. Randomized controlled trials of percutaneous transforaminal endoscopic lumbar discectomy and microendos-copy discectomy in treatment of lumbar disc herniation were collected. The eligible trials were extracted according to the inclu-sion and exclusion criteria. The Cochrane Collaboration's RevMan 5. 2 software was used for data analysis. Results A total of 4 RCTs involving 650 patients were included, 327 PTED cases and 323 MED cases were enrolled. The results of meta-analysis showed that when compared with microendoscopic discectomy, percutaneous endoscopic lumbar discectomy entailed less intra-operative blood loss(MD= -39. 49, 95%CI-64. 65 ~ -14. 32, Z=3. 08, P=0. 002), smaller incision size (MD =-10. 25, 95%CI-13. 02~ -7. 48, Z=7. 25, P<0. 00001), shorter bed time after operation(MD= -55. 42, 95%CI-66. 05~ -44. 80, Z=10. 22, P<0. 00001) and shorter hospitalization stay ( MD= -3. 95, 95%CI -5. 27~ -2. 63, Z=5. 87, P <0. 00001), but there were no significant differences in the mean operation time (MD =17. 30, 95%CI-4. 03~38. 64, Z=1. 59, P=0. 11), the visual analogue scale after operation(MD= -0. 03, 95%CI-0. 26~0. 21, Z=0. 22, P=0. 83), the improvement rate of Oswestry disability index (MD=2. 38, 95%CI -0. 93~5. 70, Z=1. 41, P=0. 16) and the rate of complications (OR=1. 36, 95%CI 0. 46~4. 04, Z =0. 55, P=0. 58). Conclusion The meta-anal-ysis shows that PTED and MED are equally effective and safe, but PTED has been found to be less invasive. Since the quality and quantity of the research included is limited, more high-quality randomized controlled trials with long-term follow-up are needed for further assessment of these outcomes.