引流在下颌阻生第三磨牙拔除后应用效果的系统评价

Drainage for the control of complications after extraction of impacted mandibular third molar: A systematic review

目的评价各种引流方法控制下颌阻生第三磨牙拔除术后并发症的有效性与安全性。方法明确评价各种引流方法控制下颌阻生第三磨牙拔除术后并发症的有效性与安全性的研究问题后,电子检索MEDLINE、Cochrane图书馆临床随机对照试验库、荷兰医学文摘、欧洲灰色文献数据库和中国生物医学文献数据库,检索时间截至2011年8月23日,同时对中文口腔医学杂志进行手工检索,对纳入文献的参考文献进行追索。使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。采用Revman 5.1软件进行统计分析。结果最终纳入研究的文献为9篇,其中7篇为随机对照试验,2篇为半随机对照试验。偏倚风险评价显示,7篇为中度风险,2篇为高度风险。Meta分析结果显示,引流能够增加患者术后最大张口度4.44 mm(P=0.003),明显改善患者术后面部肿胀(P<0.05),减少术后干槽症的发生率(P=0.008)。但是引流并不能够显著降低患者术后疼痛(P=0.09)。结论引流对缓解下颌阻生第三磨牙拔除术后并发症有一定的疗效和安全性,但还需要更多的临床随机对照试验的支持。

Objective To assess the efficacy and safety of drainage for the control of the complications following impacted mandibular third molar extraction. Methods To retrieve randomized controlled trials assessing the efficacy and safety of drainage for the control of the complications following impacted mandibular third molar extraction, biblio- graphic databases including MEDLINE, Cochrane Controlled Trials Register, EMBASE, OPEN SIGLE and China Biology Medicine Database（CBM） were searched on August 23~ 2011. References of the included studies and Chinese dental journals were hand-searched. The risk of bias were used by Cochrane Collaboration＇s tool and the data were extracted. Meta-analysis was done with Revman 5.1. Results Nine articles met the eligibility criteria and were included, seven randomized controlled trials and 2 quasi-randomized controlled trials. Seven of these studies had unclear risk of bias and 2 had high risk of bias. Drainage could significantly increase 4.44 mm of the post-operative maximal mouth opening （P=0.003）, relief facial swelling （P〈0.05） and reduce post-operative complications （P=0.008）. But no evidence showed that drainage had a positive effects on post-operative pain （P=0.09）. Conclusion Drainage could probably control the complications following impacted mandibular third molar extraction; but more randomized controlled trials are needed to reinforce the conclusion.