鼻内镜鼻腔泪囊吻合术联合丝裂霉素C疗效的Meta分析

Comparison of Endoscopic Dacryocystorhinostomy with Mitomycin C versus without Mitomycin C for Nasolacrimal Obstruction:A Meta-Analysis

目的系统评价鼻内镜鼻腔泪囊吻合术联合丝裂霉素C(MMC)与不联合MMC的疗效差异。方法计算机PubMed、EMbase、he Cochrane Library(2012年第12期)、VIP、WanFang Data、CBM和CNKI数据库,检索时限截至2012年12月31日,查找所有关于鼻内镜鼻腔泪囊吻合术联合丝裂霉素C(MMC组)与不联合MMC疗效(对照组)比较的随机对照试验(RCT)。按纳入和排除标准筛选文献、提取资料并评价质量后,采用RevMan 5.2.0软件进行Meta分析,证据质量分级采用GRADEpro 3.6软件。结果共纳入9个RCT。Meta分析结果显示:与对照组相比,MMC组的手术治愈率显著提高[RR=1.13,95%CI(1.04,1.22),P=0.003];MMC组术后1个月、6个月及12个月的骨床面积大于对照组[MD=6.68 mm2,95%(5.43,7.94),P<0.000 01;MD=11.61 mm2,95%CI(4.67,18.55),P=0.001;MD=15.65 mm2,95%CI(2.95,28.34),P=0.02],但在术后3个月,MMC组的骨床面积与对照组相比[MD=8.20 mm2,95%CI(–6.67,23.08),P=0.28];同时MMC组的手术时间明显延长[MD=10.1min,95%CI(8.00,12.20),P<0.000 01]。结论鼻内镜鼻腔泪囊吻合术联合应用丝裂霉素C可以显著提高手术成功率,可有效避免骨窗的过度缩小。

Objective To systematically review the effectiveness of endoscopic dacryocystorhinostomy （En-DCR） with versus without Mitomycin C （MMC） for nasolacrimal obstruction. Methods Databases such as PubMed, EMbase, CENTRAL （Issue 12, 2012）, VIP, WanFang Data, CBM and CNKI were electronically searched to collect the randomized controlled trials （RCTs） which investigated the comparison between En-DCR with and without MMC for nasolacrimal obstruction. The searched data was updated to December 31st, 2012. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of the included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2.0 software and the quality of evidences was graded using GRADEpro 3.6 software. Results A total of 9 RCTs were included in the meta-analysis. The results of meta-analysis showed that, the recovery rate in the MMC group was significantly elevated （RR=1.13, 95%CI 1.04 to 1.22, P=0.003）, the area of ostium in the MMC group was bigger at 1, 6 and 12 months than in the control group, postoperatively （MD=6.68 mm2, 95% 5.43 to 7.94, P〈0.000 01; MD=11.61 mm2, 95%CI 4.67 to 18.55, P=0.001; MD=15.65 mm2, 95%CI 2.95 to 28.34, P=0.02）, respectively, but the area of ostium in the MMC group at the third month was bigger than that in the control group （MD=8.20 mm2, 95%CI –6.67 to 23.08, P=0.28）. The operative time was significantly prolonged in the MMC group （MD=10.1 min, 95%CI 8.00 to 12.20, P〈0.000 01）.