咽鼓管球囊扩张术治疗咽鼓管功能障碍的系统评估及Meta分析

Balloon Eustachian tuboplasty for treatment of Eustachian tube dysfunction:A systematic review and Meta-analysis

目的:通过Meta分析系统评价咽鼓管球囊扩张术(BET)在咽鼓管功能障碍(ETD)患者治疗中的临床疗效、复发率、并发症、协同手术疗效。方法:检索PubMed、OVID、Embase、Cochrane Library、ProQuest、Web of Science、中国生物医学文献数据库、维普、万方、CNKI数据库(自建库至2020年3月),检索BET在ETD患者治疗方面的文献并进行筛选,选取随机对照研究(RCT)或NOC评分较高的病例对照研究,对符合纳入标准的文献进行Cochrane评价,并用RevMan5.2软件对符合质量标准的研究进行Meta分析。结果:共纳入14篇文献,分析结果显示BET手术总有效率86%(95%CI:0.79~0.94),且差异有统计学意义。BET术后患者鼓室图、ETS评分、ETDQ-7评分较对照组明显改善,差异有统计学意义(P<0.05),其中鼓室图、ETS评分的异质性相对较小,分别为I2=51%(OR=3.57,95%CI:1.95~6.55)、I2=59%(SMD=1.33,95%CI:0.98~1.67)。BET同期行鼓膜穿刺疗效与单纯BET手术比较差异无统计学意义。纳入文献的复发率为5.37%,并发症发生率仅为0.33%。结论:BET可以作为成人ETD治疗的一项安全有效的治疗方式,但协同手术及评估方式方面仍需要更多同质、多中心的RCT来获得更准确结论以指导临床实践。

Objective:To sysetematically evaluate the efficacy,compliance and collaborative operation of Balloon Eustachian tuboplasty(BET)for treatment of Eustachian tube dysfunction via Meta-analysis.Method:The PubMed,OVID,Embase,Cochrane Library,ProQuest,Web of Science,Chinese biomedical literature database,VIP database,WanFang database,CNKI were searched for papers on autoinflation for treatment of chronic otitis media with effusion in children(up to March 2020).Statistical analysis was performed by using Cochrane tools and RevMan5.2.Result:A total of 14 articles were included.The results of Meta-analysis showed that the effective rate of the BET was 86%(95%CI:0.79-0.94),and had statistical significance.The tubomanometry,ETS,ETDQ-7 of postoperative BET was better than that of the control group,and had statistical significance.Heterogeneity of tubomanometry,ETS was relatively small,which is I^2=51%(OR 3.57,95%CI:1.95-6.55)and I^2=59%(SMD 1.33,95%CI:0.98-1.67)respectively.There was no statistical significance between BET plus tympanic paracentesis compared with those treated with BET alone.The recurrence rate of the included literature was 5.37%and the complication rate was only 0.33%.Conclusion:Balloon Eustachian tuboplastycan be a safe and effective treatment for adult Eustachian tube dysfunction.However,in terms of collaborative surgery and evaluation methods,we still need more homogeneous,multi-center randomized controlled studies to obtain more accurate conclusions to guide clinical practice.