腺样体切除术治疗儿童分泌性中耳炎的系统评价

A systematic review of adenoidectomy in the treatment of otitis media with effusion in children

目的:系统评价腺样体切除术治疗儿童分泌性中耳炎的疗效及其安全性。方法:采用系统评价的方法,计算机检索PubMed,Medline,Elisevier,Ovid数据库,中国生物医学文献数据库,中国学术期刊全文数据库,维普中文科技期刊数据库和万方医学数据库。纳入腺样体切除术治疗儿童分泌性中耳炎的随机对照试验。根据Cochrane系统评价标准评价纳入研究的质量,对同质研究采用RevMan 5.2软件进行Meta分析,对不能进行Meta分析的数据进行描述性的定性分析。结果:腺样体切除术(联合鼓膜切开或穿刺术)在减少急性中耳炎发生、清除中耳积液方面均优于非手术(联合鼓膜切开或穿刺术);腺样体切除术联合鼓膜置管术在清除中耳积液、改善听力方面均优于鼓膜置管术。3篇文献描述了术后再出血、初期恶性高热、术后肺炎、腭咽功能不全等并发症。结论:我们的研究显示腺样体切除术在清除中耳积液方面有一定疗效;在改善听力方面腺样体切除术联合鼓膜置管术优于鼓膜置管术。目前尚无证据表明腺样体切除术有严重的术后并发症。

Objective：Systematic reviews and Meta-analysis were conducted to assess the efficacy and security of adenoidectomy for the treatment of otitis media with effusion in children.Method：Based on the principles and methods of Cochrane systematic reviews,literature was searched in PubMed,Medline,Elisevier,Ovid,CBM,CNKI,VIP and Wanfang datebases.Randomized controlled trials about treatment of otitis media with effusion in children using adenoidectomy were included.Meta-analysis was performed for the result of homogeneous studies using RevMan 5.2software.Result：Adenoidectomy（combined with myringotomy or puncture）was superior to non-surgical（combined with myringotomy or puncture）treatment in reducing the incidence of acute otitis media and removing the middle ear effusion.Adenoidectomy combined with tympanostomy tube was superior to tympanostomy tube alone in the removal of the middle ear effusion and improvement of hearing level.Three trials described some postoperative complications including haemorrhage,incipient malignant hyperthermia,postoperative pneumonia and velopharyngeal insufficiency.Conclusion：Our research shows a benefit of adenoidectomy in the removal of middle ear effusion in children with OME.Adenoidectomy combined with tympanostomy tube was superior to tympanostomy tube alone in improving hearing level.At present,there is no evidence of serious postoperative complications after adenoidectomy.