完壁式与开放式乳突根治疗效的Meta分析

Meta-analysis of curative effect of canal wall down and canal wall up mastoidectomy

目的:比较完壁式(canal wall up,CWU)与开放式(canal wall down,CWD)乳突根治鼓室成形术治疗慢性化脓性中耳炎与中耳胆脂瘤的疗效。方法:通过计算机检索中国知网期刊数据库(CNKI)、万方数据库、维普数据库(VIP)、PubMed、Cochrane Library、Web of Science及Elsevier Clinicalkey数据库从2000年1月至2019年12月的文献,纳入比较CWU与CWD乳突根治鼓室成形术治疗慢性化脓性中耳炎与中耳胆脂瘤疗效的随机对照研究与病例对照研究。采用RevMan5.3软件包对纳入文献进行Meta分析,分析两种术式的术后气导听阈(pure tone average,PTA)、术后气骨导差气骨导差(air bone gap,ABG)、并发症、干耳时间与复发率。结果:共9篇符合纳入标准的文献,其中5篇为随机对照研究,4篇为病例对照研究。总患病耳数为778耳,348耳行CWU乳突根治鼓室成形术,430耳行CWD乳突根治鼓室成形术。两种手术方式的平均PTA差异有统计学意义(MD=−6.99,95%CI:−12.40~−1.58,P=0.01),CWU较CWD好;两种手术方式的术后ABG差异无统计学意义(MD=−2.88,95%CI:−7.11~1.35,P=0.18);CWU及CWD的复发率分别为20.6%(20/97)和4%(4/98),差异具有统计学意义(OR=5.42,95%CI:1.92~15.31,P=0.001);与CWD相比,CWU手术并发症少(OR=0.37,95%CI:0.14~0.96,P=0.04),干耳时间短(MD=–15.19,95%CI:–19.12~–11.27,P<0.001),差异具有统计学意义。结论:CWU乳突根治鼓室成形术干耳时间短,手术并发症少,但具有较高的复发率;与开放术式相比,CWU提高患者术后听力的效果并不显著。手术方案需结合患者的病变性质、病变程度、术前听力状况、随访条件及医师的技术能力等方面来制定。

Objective:In order to compare the efficacy of canal wall down(CWD)and canal wall up(CWU)mastoidectomy with tympanoplasty in treating chronic suppurative otitis media and middle ear cholesteatoma.Methods:Thhe bibliographic data from January 2000 to December 2019 was retrieved from China HowNet Periodical Database(CNKI),Wanfang Database,VIP Database,PubMed Database,Cochrane Library,Web of Science and Elsevier Clinicalkey Database by computer.The included literature was in randomized control study and case control study,which was to compare the efficacy of CWD and CWU mastoidectomy with tympanoplasty in the treatment of chronic suppurative otitis media and middle ear cholesteatoma.The RevMan5.3 software package was used to perform a Meta-analysis.The postoperative pure tone average(PTA),postoperative air bone gap(ABG),complications,ear-dry time and recurrence rate were analyzed.Results:Totally 9 articles met the inclusion criteria,including 5 randomized control studies and 4 case control studies.The total number of ears affected was 778:348 ears were obtained CWD mastoidectomy with tympanoplasty surgery and 430 ears were obtained CWU mastoidectomy with tympanoplasty surgery.The difference of PTA in average between the two methods of surgery(MD=−6.99,95%CI:−12.40 to−1.58,P=0.01)was statistically significant,and CWU was better than CWD.However,there was no significant difference in ABG after surgery between the two surgical methods(MD=−2.88,95%CI:−7.11 to 1.35,P=0.18).The recurrence rates of the two procedures were 20.6%(CWU,20/97)and 4%(CWD,4/98),with a statistically significant difference(OR=5.42,95%CI:1.92 to 15.31,P=0.001);compared with CWD,fewer complications occurred in CWU(OR=0.37,95%CI:0.14 to 0.96,P=0.04),and the ear-dry time was shorter(MD=–15.19,95%CI:−19.12 to−11.27,P<0.001),with a statistically significant difference.Conclusion:CWU mastoidectomy with tympanoplasty has shorter ear-dry time and fewer surgical complications,but has a higher recurrence rate.Compared with CWD,the effect of improving postoperative hearing is not significant.The surgical plan needs to be formulated in accordance with the nature,extent,preoperative hearing status,follow-up conditions of the patient,and technical capabilities of doctors.