激光技术在胆脂瘤手术中的应用：系统评价与Meta分析。

文献信息

中文摘要

目的： 评估激光辅助胆脂瘤手术与传统技术相比的有效性，重点关注残留病变、术后并发症和听力保留。方法：按照PRISMA指南进行系统评价和Meta分析。检索数据库以寻找比较激光与非激光胆脂瘤手术的研究。筛选合格研究，并使用随机效应模型计算风险比（RR）及95%置信区间（CI）。结果：三项研究包括271名参与者报告了残留病变结果。合并风险比为RR = 0.53；95% CI，0.12-2.39；P = .406，表明激光组与非激光组之间无统计学显著差异。观察到中度异质性（I2 = 63.5%）。仅一项研究报告了术后并发症，RR = 1.04；95% CI，0.18-5.97。一项研究的亚组分析比较了激光鼓膜切开术与耳道激光辅助单阶段由内向外胆脂瘤手术，显示RR = 0.57；95% CI，0.15-2.19。结论：激光辅助胆脂瘤手术在残留病变和并发症发生率方面与传统手术相当。虽然激光可能提供技术优势，但当前证据有限且统计效能不足。需要更大规模、高质量试验来阐明其在胆脂瘤管理中的作用。

英文摘要

To evaluate the effectiveness of laser-assisted cholesteatoma surgery compared with conventional techniques, with a focus on residual disease, postoperative complications, and hearing preservation. A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases were searched for studies comparing laser and non-laser cholesteatoma surgery. Eligible studies were screened, and risk ratios (RR) with 95% CI were calculated using a random-effects model. Three studies including 271 participants reported residual disease outcomes. The pooled risk ratio was RR = 0.53; 95% CI, 0.12-2.39; P = .406, indicating no statistically significant difference between laser and non-laser groups. Moderate heterogeneity was observed (I2 = 63.5%). Only 1 study reported postoperative complications, with RR = 1.04; 95% CI, 0.18-5.97. A subgroup analysis from 1 study compared laser myringotomy with endaural laser-assisted single-stage inside-out cholesteatoma, showing RR = 0.57; 95% CI, 0.15-2.19. Laser-assisted cholesteatoma surgery demonstrates comparable rates of residual disease and complications to conventional surgery. While lasers may offer technical advantages, current evidence is limited and underpowered. Larger, high-quality trials are needed to clarify their role in cholesteatoma management.