【摘要】：目的:通過系統(tǒng)評價的方法,探討咽鼓管成形術(shù)(ETP)治療咽鼓管功能障礙(ETD)的有效性和安全性,并進(jìn)一步比較激光咽鼓管成形術(shù)(LETP)和球囊擴(kuò)張咽鼓管成形術(shù)(BET)之間的差異,為ETD的治療提供循證醫(yī)學(xué)證據(jù)。方法:計算機(jī)檢索中國生物醫(yī)學(xué)數(shù)據(jù)庫、中國知網(wǎng)、萬方數(shù)據(jù)庫、維普信息資源系統(tǒng)、Pub Med數(shù)據(jù)庫、EMBASE數(shù)據(jù)庫、MEDLINE數(shù)據(jù)庫,手工檢索相關(guān)的雜志、會議文獻(xiàn)、參考文獻(xiàn)等灰色文獻(xiàn),檢索時間截止2016年12月,收集所有關(guān)于ETP的研究,再從中篩選符合納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)的文獻(xiàn),用R3.3.2軟件對ETP治療ETD的主觀癥狀總改善率、A型鼓室圖總轉(zhuǎn)化率、Valsalva動作總完成率、并發(fā)癥總發(fā)生率進(jìn)行率的meta分析,并進(jìn)一步進(jìn)行亞組分析,比較LETP和BET治療ETD的主觀癥狀改善率、A型鼓室圖轉(zhuǎn)化率、Valsalva動作完成率、并發(fā)癥發(fā)生率的差異。結(jié)果:共納入20篇文獻(xiàn),共有研究對象614例(815耳),10篇文獻(xiàn)報道了主觀癥狀改率,17篇文獻(xiàn)報道了A型鼓室圖轉(zhuǎn)化率,6篇文獻(xiàn)報道了Valsalva動作完成率,9篇文獻(xiàn)報道了并發(fā)癥發(fā)生率。其主觀癥狀總改善率、A型鼓室圖總轉(zhuǎn)化率、Valsalva動作總完成率、并發(fā)癥總發(fā)生率分別為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)。亞組分析結(jié)果顯示:LETP和BET的主觀癥狀改善率分別為98%(95%CI:0.93~1.00)和94%(95%CI:0.87~0.99),P0.05;LETP和BET的A型鼓室圖轉(zhuǎn)化率分別為41%(95%CI:0.18~0.68)和76%(95%CI:0.55~0.90),P0.05;LETP和BET的Valsalva動作完成率分別為70%(95%CI:0.59~0.79)和91%(95%CI:0.63~0.98),P0.05;LETP和BET的并發(fā)癥發(fā)生率分別為8%(95%CI:0.02~0.17)和5%(95%CI:0.01~0.14),P0.05。結(jié)論:根據(jù)本文研究初步得出:(1)ETP治療成人慢性ETD短期療效確切,BET與LETP的主觀癥狀改善率無明顯差異;BET的A型鼓室圖轉(zhuǎn)化率和Valsalva動作完成率均優(yōu)于LETP,考慮可能與術(shù)前患者的中耳狀態(tài)和術(shù)后恢復(fù)方式、恢復(fù)時間的長短有關(guān)。(2)ETP治療成人慢性ETD安全可行,LETP和BET的并發(fā)癥發(fā)生率差異不明顯且均無嚴(yán)重并發(fā)癥發(fā)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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R764.9

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