微创血肿清除术治疗急性自发性幕上脑出血：一项系统评价与荟萃分析及试验序贯分析。
完整摘要 · 中文译文
背景：脑出血（ICH）是一种严重的卒中类型，与高发病率和高死亡率相关。虽然手术清除旨在减轻血肿负担并改善结局，但其相对于内科治疗的临床获益仍不确定。既往的系统评价评估了多种用于ICH的外科干预措施；然而，针对微创手术（MIS）的证据仍不太明确。因此，我们进行了一项系统评价和荟萃分析，以评估微创血肿清除术对急性自发性幕上ICH患者的有效性和安全性。 方法：本荟萃分析按照PRISMA 2020指南和Cochrane建议进行。对MEDLINE、Embase、Cochrane CENTRAL和ClinicalTrials.gov进行了从建库至2026年2月的全面检索。我们纳入了将微创血肿清除术与内科或常规外科治疗进行比较的随机对照试验。使用随机效应模型合并风险比（RR）和均数差（MD）。 结果：共纳入12项随机对照试验（RCTs），涉及超过2302名患者。微创血肿清除术显著降低了全因死亡率（RR = 0.77，95% CI 0.61-0.97；p = 0.02）和6个月死亡率（RR = 0.79，95% CI 0.64-0.96；p = 0.02）。在7天或30天死亡率方面未观察到显著差异，但观察到有利于干预组的趋势。功能结局，包括mRS 0-1和mRS 0-3，未显著改善。在次要结局中，微创方法 s与更大的血肿体积减少相关（MD = 62.47; p = 0.04），但也与更高的再出血风险（RR = 2.37; p = 0.002）和心脏事件风险（RR = 5.08; p = 0.009）相关。在缺血性卒中、肾功能衰竭、胃肠道出血、癫痫发作、尿路感染或住院时间和ICU住院时间方面未发现显著差异。 结论：微创血肿清除术可显著降低自发性脑出血患者的死亡率，尤其是采用内镜技术时；然而，它并未显著改善功能结局，并可能增加再出血和心脏事件等并发症的风险。这些结果强调了仔细选择患者和开展更多高质量试验以改进治疗策略的必要性。
完整摘要 · 英文原文
BACKGROUND: Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high morbidity and mortality. While surgical evacuation aims to reduce hematoma burden and improve outcomes, its clinical benefit over medical management remains uncertain. Previous systematic reviews have evaluated a broad range of surgical interventions for ICH; however, evidence specific to MIS remains less clearly defined. Therefore, we performed a systematic review and meta-analysis to assess the efficacy and safety of minimally invasive hematoma evacuation in patients with acute spontaneous supratentorial ICH. METHODS: This meta-analysis was performed in accordance with PRISMA 2020 guidelines and Cochrane recommendations. A comprehensive search of MEDLINE, Embase, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to February 2026. We included randomized controlled trials that compared minimally invasive hematoma evacuation with medical or conventional surgical management. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model. RESULTS: A total of 12 RCTs involving over 2302 patients were included. Minimally invasive hematoma evacuation significantly reduced all-cause mortality (RR = 0.77, 95% CI 0.61-0.97; p = 0.02) and 6-month mortality (RR = 0.79, 95% CI 0.64-0.96; p = 0.02). No significant differences were observed in 7-day or 30-day mortality, although a trend favoring the intervention was noted. Functional outcomes, including mRS 0-1 and mRS 0-3, did not improve significantly. Among secondary outcomes, minimally invasive approaches were associated with greater hematoma volume reduction (MD = 62.47; p = 0.04) but also a higher risk of rebleeding (RR = 2.37; p = 0.002) and cardiac events (RR = 5.08; p = 0.009). No significant differences were found in ischemic stroke, renal failure, gastrointestinal bleeding, seizures, urinary tract infections, or length of hospital and ICU stay. CONCLUSIONS: Minimally invasive hematoma evacuation significantly decreases mortality in patients with spontaneous ICH, especially with endoscopic techniques; however, it does not markedly enhance functional outcomes and may elevate the risk of complications such as rebleeding and cardiac events. These results underscore the necessity for meticulous patient selection and additional high-caliber trials to enhance treatment strategies.