硬膜下引流端口系统联合脑膜中动脉栓塞治疗慢性硬膜下血肿的安全性与疗效：系统综述与Meta分析
该系统综述与Meta分析纳入4项研究共341例接受SEPS联合MMAE治疗的慢性硬膜下血肿患者，汇总复发需再引流率为9.1%（95%CI 5.6-13.2），30天死亡率为2.1%（95%CI 0.2-5.3），平均住院6.6天（95%CI 6.1-7.2）。功能结局报告不一，两项研究中分别有64%和75.4%患者术后mRS 0-2。结论认为联合治疗在筛选合适的cSDH患者中显示潜力，但证据为假设生成性，需随机对照试验验证。
要点
- 联合SEPS与MMAE治疗cSDH的汇总复发率为9.1%，需再引流率低。
- 汇总30天死亡率为2.1%，围手术期并发症报告率4.0%-30.4%不等。
- 平均住院时间6.6天，功能结局报告不一，需RCT进一步验证。
核心结论
- SEPS联合MMAE在筛选合适的cSDH患者中显示较低的再治疗率，但证据为初步性，需前瞻性随机对照试验确认常规应用的可行性与安全性。
研究设计与样本
- 系统综述与Meta分析，检索Ovid Medline、Ovid Embase和Cochrane Central Register of Controlled Trials自建库至2025年8月19日，纳入4项研究共341例接受SEPS联合MMAE治疗的cSDH病例。
诊断标准与关键数值
- 汇总复发需再引流率为9.1%（95%CI 5.6-13.2，I2=0%，p=0.521）。
- 汇总30天死亡率为2.1%（95%CI 0.2-5.3，I2=23.6%，p=0.271）。
- 汇总平均住院时间为6.6天（95%CI 6.1-7.2，I2=0%，p=0.478）。
- 两项研究中分别有64%和75.4%患者术后mRS 0-2，其中一项研究显示53%患者mRS改善。
- 另一项研究报告出院时mRS中位数为2（IQR 2-3）。
临床应用与阅片要点
- 对于筛选合适的cSDH患者，SEPS联合MMAE可作为传统手术引流的微创替代方案，再治疗率较低。
- 阅片时需关注cSDH体积及中线移位等影像学改善指标，两项研究报告了包括血肿体积减小或中线移位改善的放射学好转。
局限性
- 仅纳入4项研究，样本量有限，结果异质性及报告方式不一（如功能结局报告变异大）。
- 证据为假设生成性，缺乏前瞻性随机对照试验验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: The combined use of the Subdural Evacuating Port System (SEPS) and middle meningeal artery embolization (MMAE) offers a less invasive alternative to conventional surgical drainage of chronic subdural hematomas (cSDH), while potentially maintaining low retreatment rates. We aimed to perform the first systematic review and meta-analysis to evaluate the outcomes of combined SEPS and MMAE in the treatment for cSDH.
METHODS: Searches of the following three electronic databases were undertaken: Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials. Searches were performed in each database from its inception until 19th August 2025. The primary outcome was recurrence requiring re-evacuation. Secondary outcomes included perioperative complications, mortality, length of stay (LOS), functional and radiological outcomes.
RESULTS: Four studies comprising 341 cases of SEPS and MMAE were included. Pooled recurrence rate after SEPS and MMAE was 9.1% (95% CI: 5.6-13.2, I2 = 0% [p = 0.521]). Reported complication rates varied between studies (4.0% and 30.4). Pooled 30-day mortality was 2.1% (95% CI: 0.2-5.3, I2 = 23.6% [p = 0.271]). Pooled mean length of stay (LOS) was 6.6 days (95% CI: 6.1-7.2, I2 = 0% [p = 0.478]). Functional outcomes were variably reported. In two studies, 64% and 75.4% of patients achieved postoperative mRS 0-2, with one of these studies showing an improvement in mRS among 53% of patients. In another study, median discharge mRS was 2 (IQR 2-3). Radiological improvement including reduction in the volume of cSDH or midline shift, was reported in two studies.
CONCLUSION: Preliminary evidence of combined SEPS and MMAE demonstrated its potential to achieve promising retreatment rates for well-selected cSDH patients. However, these results are hypothesis-generating, and prospective randomized controlled trials are required to inform on its feasibility and safety for routine clinical use.
引用
- Zhang JJ, Lee KS, Wee R, et al. Safety and efficacy of combined subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas: a systematic review and meta-analysis. Neuroradiology. 2026. PMID: 42089953. doi:10.1007/s00234-026-04011-x
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。