术前与术中应用丝裂霉素C对翼状胬肉手术预后的影响:一项荟萃分析

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摘要

背景:使用丝裂霉素C (MMC)已被推荐用于减少翼状胬肉手术患者的术后复发。然而,术前(PO)和术中(IO)应用丝裂霉素C的结果尚未得到充分的比较。目的:本研究旨在评估PO MMC与IO MMC在翼状胬肉治疗中的复发和并发症。方法:以“翼状胬肉”、“丝裂霉素”、“术前”和“术中”为关键词,系统检索PubMed、EMBASE和Cochrane Library。纳入比较PO MMC与IO MMC在翼状胬肉手术中的随机对照试验(RCTs)。使用偏倚风险工具进行定性评估。结果测量复发率和眼表并发症。使用Review Manager 5.3进行统计分析。结果:包括5个随机对照试验,390名参与者(390只眼睛)表现为原发性或复发性翼状胬肉。PO型MMC的翼状胬肉复发率与IO型MMC相似(RR = 1.04, 95% CI, 0.61 ~ 1.76, P = 0.89)。两种治疗方法(PO MMC与IO MMC)在眼表并发症(包括结膜并发症)方面无显著差异(RR = 1.04;95% CI, 0.61 ~ 1.76;P = 0.89),巩膜并发症(RR = 0.72;95% CI, 0.14 ~ 3.73;P = 0.70),角膜并发症(RR = 1.33;95% CI, 0.32 ~ 5.48;P = 0.70)。结论:PO - MMC与IO - MMC在控制翼状胬肉手术复发及并发症方面具有同等疗效。
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Effects of Preoperative Versus Intraoperative Application of Mitomycin C on the Outcome of Pterygium Surgery: A Meta-Analysis
Background: The use of mitomycin C (MMC) has been recommended to reduce postoperative recurrence in patients undergoing pterygium surgery. However, the outcomes with preoperative (PO) and intraoperative (IO) application of mitomycin C have not been adequately compared. Objective: This study aimed to evaluate PO MMC versus IO MMC in terms of recurrence and complications for pterygium treatment. Methods: PubMed, EMBASE, and Cochrane Library were systematically searched with the keywords “pterygium,” “mitomycin,” and “preoperative” and “intraoperative.” Randomized controlled trials (RCTs) comparing PO MMC with IO MMC in pterygium surgery were included. A risk of bias tool was used to perform qualitative assessments. Outcome measurements were recurrence and complications of the ocular surface. Review Manager 5.3 was used for statistical analysis. Results: Five RCTs with 390 participants (390 eyes) showing primary or recurrent pterygium were included. Recurrence of pterygium with PO MMC was similar to that with IO MMC (RR = 1.04, 95% CI, 0.61 to 1.76, P = 0.89). There was no significant difference between the two treatments (PO MMC vs. IO MMC) with respect to complications of the ocular surface, including conjunctival complications (RR = 1.04; 95% CI, 0.61 to 1.76; P = 0.89), scleral complications (RR = 0.72; 95% CI, 0.14 to 3.73; P = 0.70), and corneal complications (RR = 1.33; 95% CI, 0.32 to 5.48; P = 0.70). Conclusion: PO MMC was as efficient as IO MMC in controlling the recurrence and complications in pterygium surgery.
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