Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Otolaryngol. 2013 Jun;38(3):198-207. doi: 10.1111/coa.12114.
Mitomycin C has recently been used to prevent nasal synechiae and sinus ostium stenosis after endoscopic sinus surgery.
To compare nasal synechiae rate between topical Mitomycin C and saline or no treatment.
Systematic review and meta-analysis.
MEDLINE, SCOPUS, and Cochrane Register of Controlled Trials databases were used to identify studies up to January 2013.
Data were independently extracted by two reviewers (PN and KT). Studies which compared topical Mitomycin C with control where the outcomes of interest were nasal synechiae or sinus ostium stenosis were included. Baseline study characteristics, quality of study, numbers of patients between treatment and control groups, outcomes, and adverse events were extracted. A multivariate meta-analysis was separately applied for each outcome (nasal synechiae and maxillary sinus ostium stenosis).
Among 11 included studies, most studies used Mitomycin C dose of 0.4-0.5 mg/mL 1-5 mL in the middle meatus for 5 min duration. Eight studies reported synechiae with 281 and 281 nasal cavities received Mitomycin C and saline, respectively. For outcome of nasal synechiae, a multivariate meta-analysis suggested that Mitomycin C was associated with a 66% (RR = 0.34, 95% CI: 0.18-0.65) lower risk of nasal synechiae with moderate heterogeneity (I(2) = 43%, 95% CI: 0-77%). Subgroup analyses by age and history of revision could reduce the degree of heterogeneity. Mitomycin C benefits were found in subgroups of age ≤ 40 years (RR = 0.27, 95% CI: 0.05-1.50) and patients without any history of revision (RR = 0.19, 95% CI: 0.06-0.58). Five studies with 134 and 140 nasal cavities for Mitomycin C and saline were included in pooling of maxillary sinus ostium stenosis. Mitomycin C was associated with 74% (RR = 0.26, 95% CI: 0.12-0.54) lower risk of maxillary sinus ostium stenosis when compared with saline with low heterogeneity (I(2) = 5%, 95% CI: 0-85%). There was no evidence of publication bias for both poolings.
Applying Mitomycin C topically after endoscopic sinus surgery could reduce the risk of nasal synechiae and maxillary sinus ostium stenosis in short term by 66% and 74%, respectively. The treatment effects may be more beneficial in patients aged 40 years or younger or in patients without history of revision. However, our results were based on pooling trials with questionable methodological quality. Further trials with good research methodology and long-term follow-up should be conducted to confirm our results.
米托霉素 C 最近被用于预防内镜鼻窦手术后的鼻腔粘连和窦口狭窄。
比较米托霉素 C 局部应用与生理盐水或不治疗的鼻腔粘连发生率。
系统评价和荟萃分析。
使用 MEDLINE、SCOPUS 和 Cochrane 对照试验登记数据库检索截至 2013 年 1 月的研究。
两名评审员（PN 和 KT）独立提取数据。纳入比较米托霉素 C 与对照组的研究，对照组为有鼻腔粘连或窦口狭窄结局的患者。提取基线研究特征、研究质量、治疗组和对照组患者人数、结局和不良反应。对每个结局（鼻腔粘连和上颌窦口狭窄）分别进行多变量荟萃分析。
在纳入的 11 项研究中，大多数研究使用的米托霉素 C 剂量为 0.4-0.5mg/mL，在中鼻道应用 1-5mL，持续 5 分钟。8 项研究报告了粘连情况，281 个和 281 个鼻腔分别接受了米托霉素 C 和生理盐水治疗。对于鼻腔粘连的结局，多变量荟萃分析表明，米托霉素 C 使鼻腔粘连的风险降低了 66%（RR=0.34，95%CI：0.18-0.65），异质性中度（I²=43%，95%CI：0-77%）。年龄和手术史亚组分析可降低异质性程度。在年龄≤40 岁的亚组（RR=0.27，95%CI：0.05-1.50）和无任何手术史的患者亚组（RR=0.19，95%CI：0.06-0.58）中发现米托霉素 C 有获益。5 项研究纳入了 134 个和 140 个接受米托霉素 C 和生理盐水治疗的上颌窦口狭窄的鼻腔。与生理盐水相比，米托霉素 C 使上颌窦口狭窄的风险降低了 74%（RR=0.26，95%CI：0.12-0.54），异质性较低（I²=5%，95%CI：0-85%）。这两个荟萃分析均未发现发表偏倚的证据。
内镜鼻窦手术后局部应用米托霉素 C 可使短期鼻腔粘连和上颌窦口狭窄的风险分别降低 66%和 74%。在年龄 40 岁或更年轻的患者或无手术史的患者中，治疗效果可能更有益。然而，我们的结果是基于方法学质量存在疑问的荟萃分析研究。应进行具有良好研究方法和长期随访的进一步试验，以证实我们的结果。
