伴内耳畸形聋病患者人工耳蜗植入效果的Meta分析

Meta-analysis of the efficacy of cochlear implantation in deaf patients with inner ear malformation

目的:通过评估并比较内耳畸形与内耳解剖结构正常聋病患者的人工耳蜗植入效果及安全性,明确人工耳蜗植入术能否成为伴内耳畸形聋病患者重建听力的有效方式,从而指导临床工作。方法:使用相关的关键词在PubMed、医知网、维普医学、万方数据、中国医院知识书仓(CHKD)、中国知网(CNKI)等电子数据库进行文献检索,限定语种为中文和英文。提取的数据包括:作者、出版时间、诊断、治疗等。植入效果用术后并发症、电极阻抗值、行为反应T值、听觉能力、言语识别率等衡量。Meta分析根据异质性大小采用固定效应模型或者随机效应模型来分析。结果:11篇文章被纳入研究,共包括655例患者。Mondini畸形组、大前庭水管组以及合并畸形组的术后并发症、电极阻抗值、行为反应T值、听觉能力、言语识别率等结果均显示实验组与对照组差异无统计学意义。结论:人工耳蜗植入术可以成为伴有内耳畸形的聋病患者的治疗和康复手段,为听力重建提供必要条件。进一步的具有更长随访期更大样本的多民族对照研究将会增加人工耳蜗植入对于伴内耳畸形聋病患者疗效的可信度。

Objective：Assess and compare the clinical efficacy and safety of cochlear implantation in deaf patients with inner ear malformation and in the ones with normal inner ear structure,so that to clarify whether it is effective to restore hearing for the deaf patients with inner ear malformation.Method：The literature with relevant key words were retrieved in the databases including PubMed,YZ365.com,WANFANG data,CMJD,CHKD and CNKI with language limited to Chinese and English.Extracted data included author,year of publication,diagnosis,treatment,et al.The clinical efficacy of cochlear implantation was assessed by the complications,electrode impedance,behavior T-level,hearing abilities and speech discrimination.Meta-analysis was performed using random or fixed effects model according to the heterogeneity of data.Result：There were 11 randomized control studies involving 655 patients included in this study.There was no statistically significant difference among the deaf patients in mixed inner ear malformation group,Mondini group and large vestibular aqueduct syndrome group in the aspects of postoperative complications,electrode impedance,behavior T-level,hearing abilities and speech discrimination.Conclusion：Cochlear implantation could be the way of treatment and rehabilitation for deaf patients with inner ear malformation.Further controlled studies with longer follow-up periods and more multiracial cases included may help to evaluate the efficacy of cochlear implantation for deaf patients with inner ear malformation more reliably.