Objective To evaluate the clinical effectiveness of endoscopic third ventriculostomy (ETV) and ventriculal peritoneum shunt (VPS) for hydrocephalus. Methods A fully recursive literature search was conducted in PubMed (1996 to June, 2011), EMBASE (1996 to June, 2011), Cochrane Central Register of Controlled Trials (Issue 3, 2011), CBM (1996 to June, 2011), CNKI and Wanfang Database (1996 to June, 2011) in any language. The randomized or non-randomized controlled trials of hydrocephalus treated by endoscopic third ventriculostomy and ventriculal peritoneum shunt were considered for inclusion. The analyzed outcome variables were overall complications and the survival rate of all time points. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out by using RevMan 5.0 software. Results Nine published reports of eligible studies involving 1 187 participants met the inclusion criteria. Compared with VPS, ETV had no significant differences in short-term (1 or 2 years) survival rate (RR=1.02, 95%CI 0.90 to 1.16, P=0.74; RR=1.14, 95%CI 1.00 to 1.30, P=0.06), but there were significant differences between the two groups in overall complication rate (RR=0.70, 95%CI 0.57 to 0.89, P=0.001), postoperative 3-year survival rate (RR=1.23, 95%CI 1.07 to 1.41, P=0.004), and postoperative 5-year survival rate (RR=1.14, 95%CI 1.29 to 1.66, P=0.05). So the outcomes indicated ETV was superior in controlling the overall complication rate and prolonging the long-term survival rate. Conclusion Current evidence suggests that endoscopic third ventriculostomy is superior to ventriculal peritoneum shunt in reducing the overall complications and prolonging the long-term survival rate, but there is no significant difference in short-term survival rate between the two methods. The effectiveness of the two operational methods for hydrocephalus caused by all specific reasons still has to be further proved by more high-quality, multi-centered and double-blind RCTs.
目的 探讨经胼胝体-穹窿间入路切除第三脑室肿瘤术后，近期下丘脑反应的发生情况及相关因素，为防治第三脑室肿瘤术后下丘脑反应提供参考。 方法 回顾分析2003年1月－2008年12月经胼胝体-穹窿间入路切除的78例第三脑室肿瘤患者手术后近期（1个月内）下丘脑反应的发生情况，并将其按照肿瘤部位、病理性质、大小、血供、手术切除程度进行分类统计，用SPSS 13.0软件logistic 回归分析影响这些并发症的因素。 结果 78例术后下丘脑反应37例，发生率47.4%；死亡5例，下丘脑反应病死率为13.5%（5/37）。其中电解质糖代谢紊乱33例（42.3%），尿崩症27例（34.6%），激素水平低下16例（20.5%），高热6例（7.7%）。好转痊愈率：激素水平低下43.7%，其余均＞70%。第三脑室前部颅咽管瘤术后最容易发生下丘脑反应（P＜0.05）。 结论 经胼胝体-穹窿间入路切除第三脑室肿瘤术后近期存在程度不同的下丘脑反应，其发生与肿瘤部位、病理性质有密切关系。经积极治疗，大部分下丘脑反应能在术后1个月内好转甚至痊愈。