鼻窦球囊扩张治疗儿童慢性鼻窦炎的系统评价及Meta分析

doi:10.6040/j.issn.1673-3770.0.2017.373

摘要/Abstract

摘要： 目的探讨鼻窦球囊扩张术治疗儿童慢性鼻-鼻窦炎的可行性、有效性和安全性。方法对采用鼻窦球囊扩张术治疗儿童慢性鼻窦炎的前瞻性临床研究进行系统评价。结果 8个前瞻性临床研究符合纳入标准。可行性研究:纳入7个研究,235例患儿,549个病变的鼻窦,Meta分析结果显示术中98%成功开放窦口, 95%可信区间［0.95; 1.00］。有效性研究:纳入5个研究,172例患儿,比较手术前后SN-5数值的变化, Meta分析结果显示术后89%的患儿症状得到改善,95%可信区间［0.84; 0.93］。安全性研究:仅1篇研究有1例患儿术后出现眶周肿胀,1周后自行消退。结论鼻窦球囊扩张术治疗儿童慢性鼻窦炎,可行性好,疗效好,安全性好。

关键词: 鼻窦球囊扩张术, 儿童慢性鼻-鼻窦炎, 系统评价, Meta分析

Abstract: Objective To estimate the safety, feasibility, and efficacy of sinus balloon catheter dilation in the treatment of pediatric chronic rhinosinusitis. Methods PubMed, Embase, CNKI, Wanfang Data, CBM, and VIP databases were systematically searched for prospective studies from the date of establishment of the databases to June, 2017, on the therapeutic effects of sinus balloon catheter dilation in the treatment of pediatric chronic rhinosinusitis. Two reviewers independently conducted the literature search, study selection, data extraction, and quality assessment of the included studies. The meta-analysis was conducted using statistical package R. Results A total of 8 prospective studies were included. Feasibility study: 7 prospective studies involving 235 patients(549 sinuses)were included. The results of the meta-analysis showed that sinus balloon catheter dilation was successful in 98% of the cases(95%CI［0.95-1.00］). Effectiveness study: 5 prospective studies involving 172 patients were included. The SN-5 score was used to assess postoperative improvement in symptoms. The meta-analysis showed that the procedure improved symptoms in 89% of patients(95%CI［0.84 - 0.93］); and the SN-5 score decreased by 1.87 at follow-up, compared to baseline values(P<0.01). Safety study: Only one study reported a patient who experienced periorbital swelling without hematoma postoperatively; it resolved within one week with no specific treatment. Conclusion Sinus balloon catheter dilation is a safe, feasible, and effective treatment for pediatric chronic rhinosinusitis. Due to the low quality of the included studies, the conclusion should be verified by more strictly-designed, large-scale, and high-quality studies in the future.

Key words: Sinus balloon catheter dilation, Systematic review and meta-analysis, Pediatric chronic rhinosinusitis

中图分类号:

R765.41

林兴,林宗通,沈翎. 鼻窦球囊扩张治疗儿童慢性鼻窦炎的系统评价及Meta分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 79-86.

LIN Xing, LIN Zongtong, SHEN Ling.. Outcomes of sinus balloon catheter dilation in treatment of pediatric chronic rhinosinusitis: a systematic review and meta-analysis.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(6): 79-86.

参考文献

[1] 许庚,李源. 儿童慢性鼻窦炎手术治疗的思考与临床诊疗指引[J]. 中华耳鼻咽喉科杂志, 2003, 38(4):241-242.
[2] Thottam PJ, Haupert M, Saraiya S, et al. Functional endoscopic sinus surgery(FESS)alone versus balloon catheter sinuplasty(BCS)and ethmoidectomy: a comparative outcome analysis in pediatric chronic rhinosinusitis[J]. Int J Pediatr Otorhinolaryngol, 2012, 76(9):1355-1360.
[3] 韩娜,张华. 儿童慢性鼻窦炎药物治疗和手术治疗时机的选择[J]. 国际耳鼻咽喉头颈外科杂志, 2010, 34(3):181-183.
[4] Batra PS, Ryan MW, Sindwani R, et al. Balloon catheter technology in rhinology: reviewing the evidence[J]. Laryngoscope, 2011, 121(1):226-232.
[5] Levy JM, Marino MJ, McCoul ED. Paranasal sinus balloon catheter dilation for treatment of chronic rhinosinusitis: a systematic review and meta-analysis[J]. Otolaryngol Head Neck Surg, 2016, 154(1):33-40.
[6] Ramadan HH. Safety and feasibility of balloon sinuplasty for treatment of chronic rhinosinusitis in children[J]. Ann Otol Rhinol Laryngol, 2009, 118(3):161-165.
[7] Ramadan HH, Mclaughlin K, Josephson G, et al. Balloon catheter sinuplasty in young children[J]. Am J Rhinol Allergy, 2010, 24(1):54-56.
[8] 林镝,田莉,李朋,等. 内镜下球囊扩张术治疗儿童上颌窦炎的疗效[J]. 江苏医药, 2010, 36(15):1768-1770. LIN Di, TIAN Li, LI Peng. Efficacy of balloon sinuplasty via endoscopic sinus surgery in the treatment of maxillary sinusitis in children[J]. Jiangsu Med J, 2010, 36(15):1768-1770.
[9] Ahmed J, Pal S, Hopkins C, et al. Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis[J]. Coch Dat Syst Rev, 2011(7):Cd008515.
[10] Chmielik LP, Jadczyszyn J, Frckiewicz M, et al. Balloon sinuplasty with use of intra-operative navigation in children-Preliminary report[J]. New Medicine, 2011, 1(4):125-127.
[11] Ramadan HH, Bueller H, Hester ST, et al. Sinus balloon catheter dilation after adenoidectomy failure for children with chronic rhinosinusitis[J]. Arch Otolaryngol Head Neck Surg, 2012, 138(7):635-637.
[12] Wang F, Song Y, Zhang X, et al. Sinus balloon catheter dilation in pediatric chronic rhinosinusitis resistant to medical therapy[J]. Jama Otolaryngol Head Neck Surg, 2015, 141(6):526-531.
[13] 谭国林,刘鸿慧,龙娟,等. 鼻窦球囊扩张术治疗儿童慢性鼻窦炎的临床观察[J]. 中国耳鼻咽喉颅底外科杂志, 2014, 20(6):498-501. TAN Guolin, LIU Honghui, LONG Juan, et al. Effect of sinus balloon catheter dilation on management of pediatric chronic rhinosinusitis[J]. Chin J Otorhinolaryngol Skull Base Surg, 2014, 20(6):498-501.
[14] Soler ZM, Rosenbloom JS, Skarada D, et al. Prospective, multicenter evaluation of balloon sinus dilation for treatment of pediatric chronic rhinosinusitis[J]. Int Forum Allergy Rhinol, 2017, 7(3):221-229.
[15] Ramadan HH, Terrell AM. Balloon catheter sinuplasty and adenoidectomy in children with chronic rhinosinusitis[J]. Annals Otol, Rhinol Laryngol, 2010, 119(9):578-582.
[16] 沈翎,林宗通,林兴,等. 3种方法治疗儿童慢性鼻-鼻窦炎的疗效分析[J]. 中国耳鼻咽喉颅底外科杂志, 2016, 22(1):27-32. SHEN Ling, LIN Zongtong, LIN Xing, et al. Clinical analysis of three conservative treatment options for pediatric chronic rhinosinusitis[J]. Chin J Otorhinolaryngol Skull Base Surg, 2016, 22(1):27-32.
[17] 中华耳鼻咽喉头颈外科杂志编委会,中华医学会耳鼻咽喉头颈外科学分会小儿学组. 儿童鼻-鼻窦炎诊断和治疗建议(2012年,昆明)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(3):177-179.
[18] Kay DJ, Rosenfeld RM. Quality of life for children with persistent sinonasal symptoms[J]. Otolaryngol Head Neck Surg, 2003, 128(1):17-26.

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