本文選題：雙手微小切口　切入點(diǎn)：白內(nèi)障　出處：《河北醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的:采用Meta分析的方法對國內(nèi)、外有關(guān)雙手微小切口超聲乳化吸除術(shù)(bimanual microincisional cataract surgery,B-MICS)與傳統(tǒng)同軸超聲乳化吸除術(shù)( conventional coaxial small-incision cataract surgery,C-SICS)的對比臨床研究進(jìn)行綜合評價(jià)和定量分析,以術(shù)后1天、1周、1個(gè)月的裸眼視力、術(shù)后1個(gè)月的最佳矯正視力、術(shù)后1個(gè)月手術(shù)性散光、角膜內(nèi)皮細(xì)胞丟失率、平均超乳時(shí)間以及手術(shù)并發(fā)癥為觀察指標(biāo),評估這兩種術(shù)式治療白內(nèi)障的療效,探討該新型術(shù)式的優(yōu)越性,為臨床應(yīng)用提供指導(dǎo)。 方法:通過計(jì)算機(jī)檢索Medline、西文醫(yī)學(xué)期刊文獻(xiàn)數(shù)據(jù)庫、OVID、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫和中國知網(wǎng),結(jié)合手工檢索方式和文獻(xiàn)追溯的方法,全面收集國內(nèi)外1998-2009年間發(fā)表的有關(guān)B-MICS和C-SICS臨床療效的相關(guān)文獻(xiàn),制定嚴(yán)格的納入與排除標(biāo)準(zhǔn),并按照標(biāo)準(zhǔn)篩選文獻(xiàn),對納入的文獻(xiàn)進(jìn)行質(zhì)量評估,提取研究所需信息。應(yīng)用Review Manager 4.2軟件檢驗(yàn)納入文獻(xiàn)的異質(zhì)性,根據(jù)檢驗(yàn)結(jié)果選擇固定效應(yīng)模型或隨機(jī)效應(yīng)模型進(jìn)行Meta分析,以術(shù)后1天、1周、1個(gè)月的裸眼視力、術(shù)后1個(gè)月的最佳矯正視力以及術(shù)后并發(fā)癥為觀察指標(biāo),以比數(shù)比(odds ratio,OR)為效應(yīng)量,計(jì)算合并OR及其95%可信區(qū)間(95%CI);以術(shù)后1個(gè)月手術(shù)性散光、角膜內(nèi)皮細(xì)胞丟失率、平均超乳時(shí)間為觀察指標(biāo),以加權(quán)均數(shù)差值(weighted mean difference,WMD)為效應(yīng)量,計(jì)算合并WMD及其95%CI。對資料進(jìn)行敏感性分析,并通過漏斗圖法、Begg秩相關(guān)法和Egger直線回歸法來評價(jià)發(fā)表偏倚。 結(jié)果:按照文獻(xiàn)的納入與排除標(biāo)準(zhǔn),經(jīng)篩選后納入Meta分析的文獻(xiàn)共有14篇,其中關(guān)于術(shù)后1天裸眼視力的對照研究有6篇,術(shù)后1周裸眼視力的對照研究7篇、術(shù)后1個(gè)月裸眼視力的對照研究6篇、術(shù)后1個(gè)月最佳矯正視力的對照研究4篇、術(shù)后1個(gè)月的手術(shù)性散光的對照研究6篇、術(shù)后角膜內(nèi)皮細(xì)胞丟失率的對照研究7篇、平均超乳時(shí)間的對照研究7篇、手術(shù)并發(fā)癥的對照研究8篇。 1術(shù)后1天裸眼視力的對照研究的Meta分析結(jié)果顯示:B-MICS組術(shù)后1天裸眼視力≥0.5患者百分率(69.6%)大于C-MICS組(57.7%)[OR=1.82,95%CI(1.38,2.39)],差異有統(tǒng)計(jì)學(xué)意義(P0.0001)。 2術(shù)后1周裸眼視力的對照研究的Meta分析結(jié)果顯示:B-MICS組術(shù)后1周裸眼視力≥0.5患者百分率(86.99%)大于C-MICS組(74.55%)[OR=2.36,95%CI(1.27,4.37)],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 3術(shù)后1個(gè)月裸眼視力的對照研究的Meta分析結(jié)果顯示:B-MICS組術(shù)后1個(gè)月裸眼視力≥0.5患者百分率(92.44%)大于C-MICS組(88.33%)[OR=1.61,95%CI(1.08,2.41)],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 4術(shù)后1個(gè)月最佳矯正視力的對照研究的Meta分析結(jié)果顯示:B-MICS組術(shù)后1個(gè)月最佳矯正視力≥0.5患者百分率(93.31%)大于C-MICS組(89.08%)[OR=1.69,95%CI(0.93,3.07)],但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 5術(shù)后1個(gè)月手術(shù)性散光的對照研究的Meta分析結(jié)果顯示:B-MICS組術(shù)后1個(gè)月手術(shù)性散光小于C-MICS組[WMD=-0.33D,95%CI(-0.44D,-0.22D)],差異有統(tǒng)計(jì)學(xué)意義(P0.00001)。 6術(shù)后角膜內(nèi)皮細(xì)胞丟失率的對照研究的Meta分析結(jié)果顯示:B-MICS組術(shù)后角膜內(nèi)皮細(xì)胞丟失率小于C-MICS組[WMD=-7%,95%CI(-14%,0%)],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 7平均超乳時(shí)間的對照研究的Meta分析結(jié)果顯示:B-MICS組平均超乳時(shí)間小于C-MICS組[WMD=-0.06min,95%CI(-0.27min,0.15min)],但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 8手術(shù)并發(fā)癥的對照研究的Meta分析結(jié)果顯示:B-MICS組手術(shù)并發(fā)癥的發(fā)生率(7.24%)小于C-MICS組(10.99%)[OR=0.48,95%CI(0.27,0.85)],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 9將以上各指標(biāo)進(jìn)行敏感性分析,結(jié)果顯示本研究具有較好的穩(wěn)定性和可靠性。 10通過漏斗圖法、Begg秩相關(guān)法和Egger直線回歸法評價(jià)發(fā)表性偏倚,結(jié)果顯示各指標(biāo)漏斗圖基本對稱,發(fā)表性偏倚得到了有效控制。 結(jié)論:1 B-MICS較C-SICS可以減小手術(shù)性散光,使患者術(shù)后視力恢復(fù)得更快、更好; 2 B-MICS較C-SICS可以更好地保護(hù)角膜內(nèi)皮,減少角膜內(nèi)皮細(xì)胞的丟失; 3 B-MICS較C-SICS減少了手術(shù)并發(fā)癥,使該術(shù)式更加安全、可行; 4對于平均超乳時(shí)間,B-MICS與C-SICS這兩種術(shù)式無明顯差異,前者未能提高超聲乳化效率; 5敏感性分析及發(fā)表性偏倚結(jié)果顯示:本次Meta分析結(jié)果穩(wěn)定、可靠,說明B-MICS是一種有效、安全、可行的新型術(shù)式,對于治療白內(nèi)障擁有著廣闊的應(yīng)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.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R779.66

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