双手微小切口与传统同轴超声乳化吸除术治疗白内障疗效的Meta分析

发布时间：2018-03-29 06:12

本文选题：双手微小切口　切入点：白内障　出处：《河北医科大学》2010年硕士论文

【摘要】： 目的:采用Meta分析的方法对国内、外有关双手微小切口超声乳化吸除术(bimanual microincisional cataract surgery,B-MICS)与传统同轴超声乳化吸除术( conventional coaxial small-incision cataract surgery,C-SICS)的对比临床研究进行综合评价和定量分析,以术后1天、1周、1个月的裸眼视力、术后1个月的最佳矫正视力、术后1个月手术性散光、角膜内皮细胞丢失率、平均超乳时间以及手术并发症为观察指标,评估这两种术式治疗白内障的疗效,探讨该新型术式的优越性,为临床应用提供指导。方法:通过计算机检索Medline、西文医学期刊文献数据库、OVID、中国生物医学文献数据库和中国知网,结合手工检索方式和文献追溯的方法,全面收集国内外1998-2009年间发表的有关B-MICS和C-SICS临床疗效的相关文献,制定严格的纳入与排除标准,并按照标准筛选文献,对纳入的文献进行质量评估,提取研究所需信息。应用Review Manager 4.2软件检验纳入文献的异质性,根据检验结果选择固定效应模型或随机效应模型进行Meta分析,以术后1天、1周、1个月的裸眼视力、术后1个月的最佳矫正视力以及术后并发症为观察指标,以比数比(odds ratio,OR)为效应量,计算合并OR及其95%可信区间(95%CI);以术后1个月手术性散光、角膜内皮细胞丢失率、平均超乳时间为观察指标,以加权均数差值(weighted mean difference,WMD)为效应量,计算合并WMD及其95%CI。对资料进行敏感性分析,并通过漏斗图法、Begg秩相关法和Egger直线回归法来评价发表偏倚。结果:按照文献的纳入与排除标准,经筛选后纳入Meta分析的文献共有14篇,其中关于术后1天裸眼视力的对照研究有6篇,术后1周裸眼视力的对照研究7篇、术后1个月裸眼视力的对照研究6篇、术后1个月最佳矫正视力的对照研究4篇、术后1个月的手术性散光的对照研究6篇、术后角膜内皮细胞丢失率的对照研究7篇、平均超乳时间的对照研究7篇、手术并发症的对照研究8篇。 1术后1天裸眼视力的对照研究的Meta分析结果显示:B-MICS组术后1天裸眼视力≥0.5患者百分率(69.6%)大于C-MICS组(57.7%)[OR=1.82,95%CI(1.38,2.39)],差异有统计学意义(P0.0001)。 2术后1周裸眼视力的对照研究的Meta分析结果显示:B-MICS组术后1周裸眼视力≥0.5患者百分率(86.99%)大于C-MICS组(74.55%)[OR=2.36,95%CI(1.27,4.37)],差异有统计学意义(P0.05)。 3术后1个月裸眼视力的对照研究的Meta分析结果显示:B-MICS组术后1个月裸眼视力≥0.5患者百分率(92.44%)大于C-MICS组(88.33%)[OR=1.61,95%CI(1.08,2.41)],差异有统计学意义(P0.05)。 4术后1个月最佳矫正视力的对照研究的Meta分析结果显示:B-MICS组术后1个月最佳矫正视力≥0.5患者百分率(93.31%)大于C-MICS组(89.08%)[OR=1.69,95%CI(0.93,3.07)],但差异无统计学意义(P0.05)。 5术后1个月手术性散光的对照研究的Meta分析结果显示:B-MICS组术后1个月手术性散光小于C-MICS组[WMD=-0.33D,95%CI(-0.44D,-0.22D)],差异有统计学意义(P0.00001)。 6术后角膜内皮细胞丢失率的对照研究的Meta分析结果显示:B-MICS组术后角膜内皮细胞丢失率小于C-MICS组[WMD=-7%,95%CI(-14%,0%)],差异有统计学意义(P0.05)。 7平均超乳时间的对照研究的Meta分析结果显示:B-MICS组平均超乳时间小于C-MICS组[WMD=-0.06min,95%CI(-0.27min,0.15min)],但差异无统计学意义(P0.05)。 8手术并发症的对照研究的Meta分析结果显示:B-MICS组手术并发症的发生率(7.24%)小于C-MICS组(10.99%)[OR=0.48,95%CI(0.27,0.85)],差异有统计学意义(P0.05)。 9将以上各指标进行敏感性分析,结果显示本研究具有较好的稳定性和可靠性。 10通过漏斗图法、Begg秩相关法和Egger直线回归法评价发表性偏倚,结果显示各指标漏斗图基本对称,发表性偏倚得到了有效控制。结论:1 B-MICS较C-SICS可以减小手术性散光,使患者术后视力恢复得更快、更好; 2 B-MICS较C-SICS可以更好地保护角膜内皮,减少角膜内皮细胞的丢失; 3 B-MICS较C-SICS减少了手术并发症,使该术式更加安全、可行; 4对于平均超乳时间,B-MICS与C-SICS这两种术式无明显差异,前者未能提高超声乳化效率; 5敏感性分析及发表性偏倚结果显示:本次Meta分析结果稳定、可靠,说明B-MICS是一种有效、安全、可行的新型术式,对于治疗白内障拥有着广阔的应用前景。
[Abstract]:Objective: using the method of Meta analysis on domestic and foreign related bimanual microincisional phacoemulsification (bimanual microincisional cataract surgery, B-MICS) and the traditional coaxial phacoemulsification (conventional coaxial small-incision cataract surgery, C-SICS) for the comprehensive evaluation of clinical comparative study and quantitative analysis, based on the 1 day, 1 week after operation 1 months, uncorrected visual acuity, best corrected visual acuity of 1 months after surgery, 1 months after surgery, surgical astigmatism, corneal endothelial cell loss rate, time and complication of Ping Junchao milk as observation index, evaluating the curative effect of the two kinds of surgical treatment of cataract, explore the superiority of this new type of operation and to provide guidance for the clinical application.
Methods: the Medline database by computer, Western medical journal literature database, OVID, Chinese Chinese biomedical literature database and HowNet, combined with manual retrieval method and literature review, a comprehensive collection of domestic and foreign 1998-2009 years published on B-MICS and C-SICS clinical curative effect of the relevant literature, strict inclusion and exclusion criteria, and in accordance with the screening literature the standard to evaluate the quality of included literature, extraction of the desired information. Using Review Manager 4.2 software testing into the heterogeneity of literature, according to the test results, the choice of fixed effect model and random effect model of Meta analysis, in 1 days, 1 weeks after surgery, 1 months postoperative uncorrected visual acuity, 1 the best corrected visual acuity and complications were observed, the odds ratio (odds ratio OR) for the effect of the amount of calculation, with OR and 95% confidence interval (95%CI) at 1 months after operation; Surgical astigmatism, corneal endothelial cell loss rate, average phaco time was observed, using the weighted mean difference (weighted mean difference, WMD) for the effect of the amount of calculation, with WMD and 95%CI. for sensitivity analysis of the data, and through the funnel graph method, Begg rank correlation method and Egger linear regression method to evaluate publicationbias.
Results: according to the inclusion and exclusion criteria. After screening the literature included in the Meta analysis a total of 14, of which about 1 day postoperative uncorrected visual acuity control study of 6 patients after 1 weeks of control, uncorrected visual acuity of 7, postoperative control study 1 months visual acuity of 6 a control study, 1 months after surgery, the best corrected visual acuity of 4, postoperative surgical astigmatism control study for 1 months in 6, postoperative corneal endothelial cell loss rate control study of 7, average phaco time control study of 7 articles, 8 articles control study of surgical complications.
Meta analysis showed 1 days of uncorrected visual acuity. Results: after 1 B-MICS group after 1 days of uncorrected visual acuity 0.5 patients (69.6%) was higher than that of group C-MICS (57.7%) [OR=1.82,95%CI (1.38,2.39)], the difference was statistically significant (P0.0001).
Meta analysis of comparative study of the 1 week of the 2 results of visual acuity after operation: B-MICS group 1 weeks after operation, uncorrected visual acuity 0.5 patients (86.99%) was higher than that of group C-MICS (74.55%) [OR=2.36,95%CI (1.27,4.37)], the difference was statistically significant (P0.05).
Meta analysis of comparative study of 1 months visual acuity results of 3 postoperative B-MICS group after 1 months of uncorrected visual acuity 0.5 patients (92.44%) was higher than that of group C-MICS (88.33%) [OR=1.61,95%CI (1.08,2.41)], the difference was statistically significant (P0.05).
Meta analysis of the comparative study of the 4 1 months after surgery, the best corrected visual acuity showed: B-MICS group 1 months after surgery, the best corrected visual acuity of more than 0.5 patients (93.31%) was higher than that of group C-MICS (89.08%) [OR=1.69,95%CI (0.93,3.07)], but the difference was not statistically significant (P0.05).
5 Meta analysis of surgical astigmatism in 1 months after operation showed that the operative astigmatism in group B-MICS was less than that in group C-MICS and [WMD=-0.33D (95%CI (-0.44D, -0.22D)) after 1 months (P0.00001).
6 Meta analysis of corneal endothelial cell loss rate after operation showed that the loss rate of corneal endothelial cells in group B-MICS was less than that in group C-MICS, [WMD=-7% and 95%CI (-14%, 0%)], the difference was statistically significant (P0.05).
7 Meta analysis of the average breast milk time in the control study showed that the average time of breast emulsion in group B-MICS was less than that in group C-MICS, [WMD=-0.06min and 95%CI (-0.27min, 0.15min)], but the difference was not statistically significant (P0.05).
8 the Meta analysis of the control study of operative complications showed that the incidence of operative complications in group B-MICS (7.24%) was less than that in group C-MICS (10.99%) [OR=0.48,95%CI (0.27,0.85)], the difference was statistically significant (P0.05).
9 the sensitivity analysis of all the above indexes shows that the study has good stability and reliability.
10, the funnel plot method, Begg rank correlation method and Egger linear regression method were used to evaluate publication bias. The results showed that funnel plots of each index were basically symmetrical, and publication bias was effectively controlled.
Conclusion: 1 B-MICS can reduce the operation astigmatism and improve the visual acuity of the patients faster and better than C-SICS.
2 B-MICS can better protect the corneal endothelium and reduce the loss of corneal endothelial cells than C-SICS.
3 B-MICS is more safe and feasible than C-SICS.
4 for the average time of super milk, there was no significant difference between the two methods of B-MICS and C-SICS, and the former failed to improve the phacoemulsification efficiency.
5 sensitivity analysis and publication bias results showed that the Meta analysis results were stable and reliable, indicating that B-MICS is an effective, safe and feasible new surgical method. It has broad application prospects in the treatment of cataract.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66

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