影像导航手术影响内镜下鼻窦手术的围手术期发病率:文献系统回顾和Meta分析

目的尽管影像导航手术（IGS）被认为是一种有价值的工具，其对内镜下鼻窦手术（ESS）的围手术期发病率的影响尚不可知。在此采用Meta分析系统回顾了已报告文献中的资料。数据来源MEDLINE（1946年至2012年9月14日，2周）和EMBASE（1974年至2012年9月14日，37周）。回顾方法采用检索策略检索MEDLINE和EMBASE中有关ESS期间IGS并且报告了围手术期发病率原始数据的发表文章。遵循PRISMA（系统回顾和Meta分析优先报告条目）指南。同时纳入了含无IGS病例的比较性队列和病例系列。主要后果是严重及总体并发症。次要后果是眼眶和颅内损伤、严重出血、完成手术的能力以及再次手术。这些事件在固定效应模型中被定义为二分变量并且以风险率（RR）表示。结果共有2586篇文章满足检索条件，纳入了55项研究。14篇是IGS和无IGS鼻窦手术患者人群比较性队列研究并用于Meta分析。队列中，无IGS组的严重并发症更常见（RR=0．48：95％置信区间[CI]，0．28～0．82：P=0．007）。无IGS组总体并发症更多（RR=O，66；95％CI，0.47～0.94：P=0．02）。所有其他结局疗效在Meta分析中都未达到显著性。结论与现有评价ESS期间使用IGS的文章相反，已发表研究的证据证明，对于经选择的人群，在鼻窦手术中使用IGS的相关严重和总体并发症风险更低（与无IGS的鼻窦手术相比）。

Objective Although image-guided surgery （IGS） is considered a valuable tool, its impact on perioperative morbidity for endoscopic sinus surgery （ESS） remains unclear. The evidence from reported literature is systematically reviewed with meta-analysis. Data Sources MEDLINE （1946 to September 14, 2012, week 2） and EMBASE （1974 to September 14-2012, week 37） . Review Methods MEDLINE and EMBASE were searched using a search strategy for publications on IGS during ESS that reported original data on perioperative morbidity. PRISMA （Preferred Reporting Items for Systematic reviews and Meta-Analyses） guidelines were followed. Both comparative cohort studies with non-IGS cases and case series were included. Primary outcome was major and total complications. Secondary outcomes were specific orbital and intracranial injury, major hemorrhage, ability to complete the operation, and revision surgery. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio （RR） in a fixed-effects model. Results In total, 2586 articles fulfilled the search, producing 55 included studies. Fourteen were comparative cohorts of IGS and non-IGS sinus surgical patient populations used for meta-analysis. Among the cohorts, major complications were more common in the non-IGS group （RR = 0.48; 95% confidence interval [CI], 0.28～0.82; P=0.007） . Total complications were greater in the non-IGS group （RR = 0.66; 95% CI, 0.47～0.94; P =0.02） . All other outcomes did not reach significance on meta-analysis. Conclusion Contrary to current review articles on the topic of IGS use during ESS, there is evidence from published studies that the use of IGS for sinus surgery, within selected populations, is associated with a lower risk of major and total complications compared with non-IGS sinus surgery.