完壁式与开放式乳突根治术治疗胆脂瘤中耳炎疗效的国内文献Meta分析

A Systematic Review of the Therapeutic Effects of Intact Canal Wall Mastoidectomy and Open Mastoidectomy for Cholesteatoma Otitis Media

目的 通过Meta分析的方法对国内报道的完壁式与开放式乳突根治术治疗胆脂瘤中耳炎疗效的文献进行系统评价。方法计算机检索维普中文科技期刊全文数据库（VIP）（1989-2015年）、中国万方数据库（1999-2015年）、中国知网（CNKI）（1994-2015年）、学术期刊网络出版总库（CAJD）数据库中关于应用完壁式与开放式乳突根治术治疗胆脂瘤中耳炎的临床随机对照试验（RCT）的国内相关文献,对符合要求的RCT进行Meta分析。结果 最终纳入符合标准的文献18篇,共有1 069例患者,随访时间3个月-7年不等;Meta分析结果显示,完壁式乳突根治术组比开放式乳突根治术组的手术时间短[总效应Z=15.54,MD=-18.36,95%CI（-24.54,-12.18）,P〈0.000 01],干耳时间短[总效应Z=8.64,MD=-13.90,95%CI（-17.05,-10.75）,P〈0.000 01],并发症少[总效应Z=7.63,OR=0.19,95%CI（0.12,0.29）,P〈0.000 01],术后气导听阈降低〉10dB的病例多[总效应Z=2.83,OR=2.47,95%CI（1.32,4.61）,P=0.005],气骨导差〈20dB的病例多[总效应Z=3.05,OR=1.60,95%CI（1.18,2.17）,P=0.002],两种术式复发率差异无统计学意义[总效应Z=1.92,OR=1.87,95%CI（0.99,3.53）,P=0.05]。结论 在两种手术方式均可行的情况下,完壁式乳突根治术较开放式乳突根治术治疗胆脂瘤中耳炎的手术时间及干耳时间短,并发症少,术后听力提高更优,但复发率无明显差异。

Objective To carry out a meta-analysis on the published data to evaluate therapeutic effects of intact canal wall mastoidectomy and open mastoidectomy for cholesteatoma otitis media.Methods A comprehensive search was performed in VIP（1989-2015）,WANFANG（1999-2015）,CNKI（1994-2015）and CAJD databases to collect the randomized controlled trials（RCTs）on the intact canal wall mastoidectomy and open mastoidectomy treat cholesteatoma otitis media,and to analyze the RCTs in meta-analysis method.Results 1 069 patients were analyzed in the 18 RCTs which met the inclusion criteria.Patients were followed up from 3months to 7years.The meta-analysis results suggested that,compared with the open mastoidectomy group,the patients had less operative time（test for overall effect：Z=15.54,MD=-18.36,95%CI（-24.54,-12.18）,P0.000 01）,less dry ear time（test for overall effect：Z=8.64,MD=-13.90,95%CI（-17.05,-10.75）,P0.000 01）,less complications（test for overall effect：Z=7.63,OR=0.19,95%CI（0.12,0.29）,P0.000 01）,and more patients with decreased pure tone air conduction thresholds10dB（test for overall effect：Z=2.83,OR=2.47,95%CI（1.32,4.61）,P=0.005）,more patients with air-bone gaps20dB（Z=3.05,OR=1.60,95%CI（1.18,2.17）,P=0.002）,but the recurrent rate is not different significantly（test for overall effect：Z=1.92,OR =1.87,95%CI（0.99,3.53）,P=0.05）.Conclusion The illness is suitable to be treated by using the two surgical ways while the intact canal wall mastoidectomy treatment takes less operative time,dry ear time and complications,and improve hearing more significantly than the open mastoidectomy,but the recurrent rate is not different significantly for treating cholesteatoma otitis media.