鼓膜置管及其合并腺样体切除治疗儿童分泌性中耳炎听力改善的疗效分析:Meta分析

Comparative hearing outcomes of tympanostomy tubes and combined with adenoidectomy for pediatric otitis media effusion treatment:a Meta-analysis

目的研究鼓膜置管以及鼓膜置管合并腺样体切除治疗儿童分泌性中耳炎的听力改善疗效。方法通过Pub Med、EMBASE、the Cochrane Library、MEDLINE等数据库检索国内外已发表相关文献,选择鼓膜置管、鼓膜置管合并腺样体切除治疗儿童分泌性中耳炎的随机对照研究,采用Cochrane_Hand-book中提供的Risk of Bias Table标准对符合纳入标准的文献进行质量评价,采用Review Manager(版本5.02)进行meta分析、异质性检验,并绘制森林图。结果共有4个临床随机对照实验纳入分析。随访6个月时单纯鼓膜置管与鼓膜置管联合腺样体切除两者听力改善程度无明显差异(WMD=1.06,95%CI:0.18~2.29,P=0.09),随访12个月时患儿听力提高程度上鼓膜置管联合腺样体切除要优于单纯鼓膜置管,差异有统计学意义(WMD=3.03,95%CI:0.91~5.14,P=0.005)。结论 Meta分析显示,在儿童分泌性中耳炎治疗中,予以鼓膜置管、腺样体切除同期手术可改善患儿远期的听力情况。

Objective To investigate the hearing outcome efficiency of tympanostomy tubes and when combined with adenoidectomy for otitis media with effusion treatment. Methods A systematic literature review of tympanostomy tubes and tympanostomy tubes combined with adenoidectomy were performed using PubMed, EMBASE, the Cochrane Library, MEDLINE, all of the included studies were randomized controlled trial. The quality of included studies was evaluated according to the Risk of Bias Table of the Cochrane Handbook. Data were analyzed with Review Manager 5.02 software. Heterogeneity was examined, and forest plot was drawn. Results All of the included 4 studies were randomized controlled trials. At 6 month follow-up patients, the tym- panostomy tubes and tympanostomy tubes combined with adenoidectomy had no difference in hearing improvement （WMD = 1.06, 95%CI-0.18 - 2.29, P = 0.09）. At 12 month follow-up patients, the tympanostomy tubes com- bined with adenoidectomy were better than tympanostomy tubes alone （WMD = 3.03, 95%CI 0.91 - 5.14, P = 0.005 ）. Conclusions The meta analysis result reveals that tympanostomy tubes combined with adenoidectomy have an advantage in long term follow up time for hearing improvement in children＇s otitis media with effusion treatment.