咽鼓管球囊扩张联合鼓膜切开置管对慢性复发性分泌性中耳炎疗效的Meta分析

Efficacy of balloon dilation Eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media:a Meta-analysis

目的系统评价咽鼓管球囊扩张联合鼓膜切开置管对慢性复发性分泌性中耳炎的治疗效果。方法在万方,中国知网(CNKI),维普(VIP),中国生物医学文献(CBM),PubMed,Web of science,Cochrane library等中外文数据库中检索自建库以来至2020年3月有关咽鼓管球囊扩张治疗慢性复发性分泌性中耳炎的相关文献。将所有相关文献严格按照纳入排除标准进行筛选,并依据Cochrane文献质量评价表对最终纳入文献进行质量评估。采用Revman 5.3软件对纳入文献的有效率、ETDQ-7评分、骨气导差、平均听阈、声导抗、耳内镜检查、不良反应发生率等结局指标进行Meta分析。结果最终纳入文献14篇,共计14个RCT实验710例患者(790耳),试验组351例患者(395耳),对照组359例患者(395耳)。试验组采用咽鼓管球囊扩张联合鼓膜切开置管,对照组为单纯鼓膜切开置管。Meta分析结果显示:试验组各个随访时间段的有效率均高于对照组,差异具有统计学意义(P均<0.000 01);在各个随访时间段中,试验组的ETDQ-7评分均低于对照组且差异具有统计学意义(P均<0.000 01);随访1个月及6个月后,两组的骨气导差变化无统计学差异。随访12个月后,试验组患者的骨气导差较对照组改善明显,差异具有统计学意义(P<0.05);试验组的平均听阈、声导抗及耳内镜检查的改善情况优于对照组,差异具有统计学意义(P均<0.05);另外,试验组患者的不良反应发生率低于对照组,差异具有统计学意义(P<0.05)。结论相比单纯鼓膜切开置管,咽鼓管球囊扩张联合鼓膜切开置管对慢性复发性分泌性中耳炎疗效较好,症状改善更明显且不良反应发生率较小。

Objective To comprehensively evaluate the clinical efficacy of balloon dilation Eustachian tuboplasty(BET)combined with tympanic tube insertion(TTI)for the treatment of chronic recurrent secretory otitis media.Methods Articles about the treatment of chronic recurrent secretory otitis media by BET were searched in Wanfang data,CNKI,VIP,CBM,PubMed,Web of science and Cochrane library from database establishment to March 2020.All the relevant literatures were screened in strict accordance with the inclusion and exclusion criteria,and the extracted literatures were evaluated according to the Cochrane Literature Quality Evaluation Table.Meta-analysis was conducted on the outcome assessment indexes including the effective rate,the Eustachian Tube Dysfunction Questionaire(ETDQ-7)score,air-bone gap,average hearing threshold,acoustic immitance,otoendoscopy,incidence rate of adverse reaction and so on using Revman 5.3 software.Results Fourteen randomized controlled trials(RCT)with 710 patients(790 ears)were extracted,including 351 patients(395 ears)in the experimental group and 359 patients(395 ears)in the control group.The patients in the experimental group received BET combined with TTI,while those in the control group were treated by simple TTI.Meta-analysis results showed that the total effective rates at different time points(3,6 and 12 months after treatment)in the experimental group were higher than those in the control group(all P<0.00001).The ETDQ-7 values at different time points in experimental group were lower than those in the control group,and the differences were statistically significant(all P<0.00001).The difference of air-bone gap at 12 months after treatment between the experimental group and the control group was statistically significant(P<0.05)while those at one and 6 months were insignificant.The improvements in the average hearing threshold,tympanometry,endoscopic signs of the experimental group were better than those of the control group(all P<0.05).The incidence rate of adverse reactions in the experimental group was lower than that in the control group with statistically significant difference(P<0.05).Conclusion Compared with TTI alone,BET combined with TTI can significantly improve the therapeutic effect of chronic recurrent secretory otitis media and reduce adverse reactions.