咽鼓管成形术治疗咽鼓管功能障碍有效性与安全性的meta分析

发布时间：2019-05-07 05:16

【摘要】：目的:通过系统评价的方法,探讨咽鼓管成形术(ETP)治疗咽鼓管功能障碍(ETD)的有效性和安全性,并进一步比较激光咽鼓管成形术(LETP)和球囊扩张咽鼓管成形术(BET)之间的差异,为ETD的治疗提供循证医学证据。方法:计算机检索中国生物医学数据库、中国知网、万方数据库、维普信息资源系统、Pub Med数据库、EMBASE数据库、MEDLINE数据库,手工检索相关的杂志、会议文献、参考文献等灰色文献,检索时间截止2016年12月,收集所有关于ETP的研究,再从中筛选符合纳入标准和排除标准的文献,用R3.3.2软件对ETP治疗ETD的主观症状总改善率、A型鼓室图总转化率、Valsalva动作总完成率、并发症总发生率进行率的meta分析,并进一步进行亚组分析,比较LETP和BET治疗ETD的主观症状改善率、A型鼓室图转化率、Valsalva动作完成率、并发症发生率的差异。结果:共纳入20篇文献,共有研究对象614例(815耳),10篇文献报道了主观症状改率,17篇文献报道了A型鼓室图转化率,6篇文献报道了Valsalva动作完成率,9篇文献报道了并发症发生率。其主观症状总改善率、A型鼓室图总转化率、Valsalva动作总完成率、并发症总发生率分别为96%(95%CI:0.92~0.99)、65%(95%CI:0.48~0.79)、79%(95%CI:0.65~0.88)和6%(95%CI:0.02~0.12)。亚组分析结果显示:LETP和BET的主观症状改善率分别为98%(95%CI:0.93~1.00)和94%(95%CI:0.87~0.99),P0.05;LETP和BET的A型鼓室图转化率分别为41%(95%CI:0.18~0.68)和76%(95%CI:0.55~0.90),P0.05;LETP和BET的Valsalva动作完成率分别为70%(95%CI:0.59~0.79)和91%(95%CI:0.63~0.98),P0.05;LETP和BET的并发症发生率分别为8%(95%CI:0.02~0.17)和5%(95%CI:0.01~0.14),P0.05。结论:根据本文研究初步得出:(1)ETP治疗成人慢性ETD短期疗效确切,BET与LETP的主观症状改善率无明显差异;BET的A型鼓室图转化率和Valsalva动作完成率均优于LETP,考虑可能与术前患者的中耳状态和术后恢复方式、恢复时间的长短有关。(2)ETP治疗成人慢性ETD安全可行,LETP和BET的并发症发生率差异不明显且均无严重并发症发生。
[Abstract]:Objective: to evaluate the efficacy and safety of eustachian tube angioplasty (ETP) in the treatment of (ETD) with eustachian tube dysfunction. The difference between laser eustachian angioplasty (LETP) and balloon dilated eustachian angioplasty (BET) was further compared in order to provide evidence-based medical evidence for the treatment of ETD. Methods: Chinese biomedicine database, Chinese knowledge website, Wanfang database, Pub Med database, EMBASE database, MEDLINE database, related journals and conference documents were searched by computer. Grey literatures, such as references, were retrieved until December 2016, and all studies on ETP were collected, from which the articles that met the inclusion criteria and exclusion criteria were screened, and the total improvement rate of subjective symptoms of ETP treatment with R3.3.2 software was achieved by using R3.3.2 software. Meta analysis of total conversion rate of type A tympanogram, total completion rate of Valsalva action and total rate of complication were performed, and subgroup analysis was carried out to compare the improvement rate of subjective symptoms, conversion rate of type A tympanogram and complete rate of Valsalva action between LETP and BET in treatment of ETD. Differences in the incidence of complications. Results: a total of 20 articles were included, including 614 cases (815 ears), 10 articles reported the improvement rate of subjective symptoms, 17 articles reported the conversion rate of type A tympanogram, and 6 articles reported the completion rate of Valsalva action. The incidence of complications was reported in 9 articles. The total improvement rate of subjective symptoms, the conversion rate of type A tympanogram, the total completion rate of Valsalva action and the total incidence of complications were 96% (95%CI:0.92~0.99) and 65% (95%CI:0.48~0.79), respectively. 79% (95%CI:0.65~0.88) and 6% (95%CI:0.02~0.12). The results of subgroup analysis showed that the improvement rates of subjective symptoms in LETP and BET were 98% (95%CI:0.93~1.00) and 94% (95%CI:0.87~0.99), P 0.05; The conversion rate of type A tympanogram of LETP and BET was 41% (95%CI:0.18~0.68) and 76% (95%CI:0.55~0.90), P 0.05, respectively. The Valsalva completion rates of LETP and BET were 70% (95%CI:0.59~0.79) and 91% (95%CI:0.63~0.98), P0.05, respectively. The complication rates of LETP and BET were 8% (95%CI:0.02~0.17) and 5% (95%CI:0.01~0.14), P 0.05. Conclusion: (1) the short-term curative effect of ETP on adult chronic ETD is definite, and the improvement rate of subjective symptoms between BET and LETP has no significant difference. The conversion rate of type A tympanogram and the completion rate of Valsalva in BET were better than those in LETP,. (2) ETP is safe and feasible in treating chronic ETD in adults, which may be related to the preoperative middle ear state, the recovery mode and the duration of recovery. (2) the treatment of chronic ETD in adults is safe and feasible. There was no significant difference in the incidence of complications between LETP and BET and no serious complications occurred.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9

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