Department of Ophthalmology, Taihe Hospital Affiliated to Hubei University of Medicine, Hubei, China.
PLoS One. 2013 May 13;8(5):e62737. doi: 10.1371/journal.pone.0062737. Print 2013.
A number of published comparative studies have been conducted to evaluate the efficacy and safety of intraoperative mitomycin C (MMC) in endoscopic dacryocystorhinostomy (EN-DCR). However, results have not always been consistent. Therefore, we carried out a meta-analysis to compare the clinical results of EN-DCR with and without MMC.
A comprehensive literature search of Cochrane Library, PubMed and EMBASE to identify relevant trials comparing EN-DCR with and without MMC. Eleven studies including 574 eyes were included in this meta-analysis. The success was defined as patency of the nasolacrimal canal and symptomatic improvement. There was significantly higher success rate in the MMC group in comparison with control group [RR = 1.12, 95% CI (1.04, 1.20), P = 0.004]. A sensitivity analysis after the non-randomized controlled trials were excluded from the meta-analysis demonstrated no differences compared with the overall results. Subgroup analyses showed that MMC group had a significantly higher success rate than control group in primary and revision EN-DCR, and EN-DCR without silicone intubation, but no difference in the subgroup of with silicone intubation. The size of the osteotomy site was bigger in the MMC group compared to the control group at 3 months [WMD = 7.65, 95% CI (0.33, 14.98), P = 0.041] and 6 months [WMD = 9.28, 95% CI (2.45, 16.11), P = 0.008] after surgery. However, there was statistically significant difference in the osteotomy surface area between the two groups at 12 months after surgery [WMD = 11.63, 95% CI (-1.04, 24.29), P = 0.072].
Intraoperative MMC application seems to be a safe adjuvant that could reduce the closure rate of the osteotomy and enhance the success rate after both primary and revision EN-DCR.
ClinicalTrials.gov NCT01772277.
有许多已发表的比较研究评估了术中丝裂霉素 C（MMC）在经内镜鼻腔泪囊吻合术（EN-DCR）中的疗效和安全性。然而，结果并不总是一致的。因此，我们进行了一项荟萃分析，比较了有和没有 MMC 的 EN-DCR 的临床结果。
通过对 Cochrane 图书馆、PubMed 和 EMBASE 的全面文献检索，确定了比较 EN-DCR 与 MMC 治疗的相关试验。本荟萃分析纳入了 11 项研究共 574 只眼。成功定义为鼻泪管通畅和症状改善。与对照组相比，MMC 组的成功率更高[RR=1.12，95%CI（1.04，1.20），P=0.004]。排除非随机对照试验后进行敏感性分析，结果与总体结果无差异。亚组分析表明，MMC 组在原发性和复发性 EN-DCR 以及无硅胶插管的 EN-DCR 中成功率明显高于对照组，但在硅胶插管亚组中无差异。与对照组相比，MMC 组在术后 3 个月[WMD=7.65，95%CI（0.33，14.98），P=0.041]和 6 个月[WMD=9.28，95%CI（2.45，16.11），P=0.008]时的截骨部位更大。然而，两组在术后 12 个月时的截骨面积存在统计学差异[WMD=11.63，95%CI（-1.04，24.29），P=0.072]。
术中应用 MMC 似乎是一种安全的辅助手段，可以降低截骨的闭合率，提高原发性和复发性 EN-DCR 后的成功率。
ClinicalTrials.gov NCT01772277。
