系统评价在泪囊鼻腔吻合术中硅胶管的应用对术后临床疗效的影响

A System Analysis of the Effect of Dacryocystorhinostomy with Silicone Intubation

目的系统评价鼻腔泪囊吻合手术中置入硅胶管与不置入硅胶管两种手术方式术后疗效差异,探讨硅胶管的有效性和安全性。方法检索Pubmed,EMBASE,Cochrane图书馆,对泪囊鼻腔吻合术中置入硅胶管与不置入硅胶管术后疗效分析的临床研究文献进行Meta分析,Meta分析的内容包括两种方式的治愈率和敏感性。统计分析采用RevMan5.0,计数资料采用优势比RR(95%CI)。结果共纳入10个研究,包括6篇随机对照试验和4篇队列研究试验,共460例(置入硅胶管249例,不置入硅胶管211例)。(1)Meta分析结果显示:置入硅胶管组和不置入硅胶管组在治愈率上差异无统计学意义,鼻内镜+激光组(RR=1.05,95%CI:0.64～1.71,P=0.850)、鼻内镜组(RR=0.95,95%CI:0.84～1.08,P=0.430)、传统外路开创组(RR=1.03,95%CI:0.95～1.13,P=0.480)。(2)敏感性分析显示:鼻内镜组和传统外路开创组,排除队列研究的文献之后,置入硅胶管组与不置入硅胶管组治愈率上差异仍无统计学意义(RR=1.33,95%CI:0.89～1.98,P=0.160;RR=1.06,95%CI:0.96～1.16,P=0.240)。而鼻内镜组,当排除队列研究的文献后,置入硅胶管组术后治愈率高于不置入硅胶管组,两者差异有统计学意义(RR=0.83,95%CI:0.71～0.97,P=0.020)。(3)并发症分析:置入硅胶管组在并发症上如肉芽增生、鼻黏膜刺激等多于不置入硅胶管组,卡方检验示两者术后并发症差异存在统计学意义(χ2=6.22,P=0.013),同时不置入硅胶管组具有费用低的优点。结论鼻腔泪囊吻合手术中置入硅胶管组与不置入硅胶管组在术后治愈率方面无明显优势,但不置入硅胶管组具有较少并发症、费用低等优点。

Objective To compare the differences in success rates of dacryocystorhinostomy （DCR） with and without silicone intu- bation, and to find out whether the use of silicone tubes is valid and safe. Methods A literature search was conducted in the PubMed, EMBASE, and Cnchrane Controlled Trials Register to identify potentially relevant controlled trials. The statistical analysis was performed using RevMan 5.0 software. Results Ten studies （460 eyes）investigating the success rates of DCR with and without silicone intubation in adults were identified. Meta analysis showed that the success rate after surgery with and without silicone intubation was not statistically significant （LA-DCR group：RR=l.05, 95% CI：0.64-1.71,P=0.850;EN-DCR group：RR =0.95, 95% CI：0.84-1.08,P= 0. 430 ; EX - DCR group ： RR = 1.03, 95 % C1：0.95 - 1.13, P = 0. 480）. Sensitivity analysis showed that when we excluding the non - randomized comparative study, the success rate after surgery with and without silicone intubation was still not statistically significant in EX-DCR group and LA-DCR group with （RR=1.33, 95% CI：0.89-1.98, P=0.160） and （RR=1.06, 95%CI：0.96- 1. 16, P =0. 240）. However, it did alter the result and a greater proportion of patients occurred postoperative failure in the intubation group （RR = 5.67; 95% C1：0.15 -30.64; P = 0. 040）. Complications analysis showed that on the contrary, the silicone intubation patients has more postoperative complications than the without silicone intubation patients（X^2 = 6.22,P = 0. 013）. Conclusion Currently there is no clear evidence that intubation in routine DCR is superior to non - intubation. Meta - analyses are limited by the quality of included studies. A well -conducted randomized control trial is needed.