中耳胆脂瘤耳内镜和显微镜手术疗效比较的Meta分析

Efficacy of endoscopic vs microscopic surgery for middle ear cholesteatoma:A Meta analysis

目的通过Meta分析比较中耳胆脂瘤经耳内镜手术(EES)和显微镜手术(MES)治疗后的疗效。方法通过计算机检索PubMed、Embase、Cochrane、Web of Science、中国生物文献数据库(CBM)、维普数据库(CQVIP),中国期刊全文数据库(CNKI)和万方数字期刊全文数据库,检索时间截止到2020年4月。纳入比较EES和MES治疗中耳胆脂瘤的随机对照试验、前瞻性研究或回顾性研究。从中提取手术时间、并发症和复发率等数据,然后对提取的数据用Review Manager 5.3软件进行Meta分析。结果共纳入10篇文献共764例中耳胆脂瘤患者,其中367例(48%)接受了EES治疗,397例(52%)接受了MES治疗。EES组在手术时间[MD=-18.61,95%CI(-22.21,-15.01),P<0.05]、手术并发症[OR=0.35,95%CI(0.19,0.67),P<0.05]、术后复发率[OR=0.28,95%CI(0.16,0.50),P<0.05]等方面合并效应的结果优于MES。结论初步证实EES治疗中耳胆脂瘤的手术时间短、并发症少、复发率低。

Objective To compare the efficacy of endoscopic ear surgery(EES)and micropic ear surgery(MES)for treatment of middle ear cholesteatoma through a Meta analysis.Methods PubMed,Embase,Cochrane,Web of Science,China Biological Database(CBM),Chongqing VIP Database(CQVIP),China National Knowledge Infrastructure(CNKI)and Wanfang Full-text Database were searched on web up to April 2020.Randomized controlled trials,prospective or retrospective studies comparing EES and MES in the treatment of middle ear cholesteatoma were included.Data such as operation time,complications and recurrence rate were extracted and included in this Meta analysis using Review Manager 5.3 software.Results A total of 764 patients with middle ear cholesteatoma from 10 articles were included,comprising 367 cases(48%)undergoing EES and 397(52%)undergoing MES.In the EES group,the composite outcome in terms of operation time[MD=-18.61,95%CI(-22.21,-15.01),P<0.05],surgical complications[OR=0.35,95%CI(0.19,0.67),P<0.05],and post-surgical recurrence[OR=0.28,95%CI(0.16,0.50),P<0.05]appeared more favorable when compared with MES.Conclusion It is preliminarily confirmed that EES as a treatment of middle ear cholesteatoma is associated with shorter operation time,fewer complications and low recurrence rate.