摘要
目的系统评价不同方法(包括不同根管外科手术和常规根管填充术等)治疗慢性根尖周病变的疗效。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、VIP、CNKI、CBM和WanFang Data中不同方法(包括根管外科手术,如根尖刮治术、倒充术、根尖切除术和常规根管充填术)治疗慢性根尖周病变的随机对照试验(RCT)和临床同期对照研究(CCT),并追溯纳入研究的参考文献,检索时限均从建库至2012年10月。由两名研究者按照纳入和排除标准独立选择文献、提取资料、评价质量并交叉核对后,采用RevMan 5.0软件进行Meta分析。结果共纳入7个RCT和11个CCT,1 663例患者,合计1 727颗牙,其中1 661颗符合纳入标准(根管外科手术组1 151颗,常规治疗组510颗)。纳入研究的方法学质量均较低。Meta分析结果显示:总体而言,不同根管外科治疗+根管充填术治疗的疗效优于单纯根管充填术治疗[RR=1.12,95%CI(1.08,1.18),P<0.000 01]。亚组分析结果显示,根管倒充术和根尖切除术的总有效率均优于根尖刮治术,两组差异均有统计学意义[RR=1.3,95%CI(1.15,1.46),P<0.000 1;RR=1.23,95%CI(1.04,1.46),P=0.02];而根管倒充术与根尖切除术的疗效相当,两组差异无统计学意义[RR=0.96,95%CI(0.83,1.11),P=0.61]。结论本系统评价结果提示,根管充填术治疗+根管外科治疗慢性根尖周病变的疗效优于单纯根管充填术治疗;而不同根管外科手术治疗的比较结果显示,根尖切除和根管倒充术疗效均优于根尖刮治术。受纳入研究数量与质量限制,加之根管充填术与根管外科治疗在临床中很难实施操作者和患者盲法,可能存在测量偏倚,因此上述结论还需通过设计严谨的高质量随机对照试验验证。
Objective To systematically review the effectiveness of different therapies for chronic periapical lesion （CPL）, such as different root canal surgeries and conventional root canal obturation. Methods The following databases such as The Cochrane Library, MEDLINE, EMbase, VIP, CNKI, CMB and WanFang Data were searched to collect the randomized controlled trials （RCTs） and concurrent controlled trials （CCTs） on CPL treated by both conventional root canal obturation and different root canal surgeries such as periapical curettage, retrograde obturation and apicoectomy. The references of the included studies were also retrieved, and the retrieval time was from inception to October 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality. Then after cross-checking, the meta-analyses were performed by using RevMan 5.0 software. Results A total of 7 RCTs and 11 CCTs involving 1 663 patients were included. Among all 1 727 teeth, 1 661 met the inclusion criteria which contained 1 151 in the root canal surgeries groups, and 510 in the conventional groups, The meth- odological quality of all included studies was low. The results of meta-analysis showed that, in general, different root canal surgeries plus conventional root canal obturation were more effective than root canal obturation alone （RR=I.12, 95%CI 1.08 to 1.18, P〈0.000 01）. The results of sub-group analysis revealed that, the total effective rate of both retrograde obtura- tion （RR=I.3, 95% CI 1.15 to 1.46, P〈0.000 1） and apicoectomy （RR=1.23, 95% CI 1.04 to 1.46, P=0.02） was superior to that of periapical curettage, with significant differences in both sub-groups. But retrograde obturation took similar effect as apicoectomy did, without a significant difference （RR=0.96, 95% CI 0.83 to 1.11, P=0.61）. Conclusion This systematic review suggests that, root canal obturation plus root canal surgeries is superior to root canal obturation alone in treat- ing chronic periapical lesions. The comparison among different root canal surgeries reveals that, both apicoectomy andretrograde obturation are superior to periapical curettage. For the quantity and quality limitation of the included studies, additionally, the possibly existing bias because it is difficult to conduct surgeon and patient blind methods in root canal obturation and root canal surgeries in clinic, so the above conclusion has to be further proved by performing more well- designed and high quality RCTs.
出处
《中国循证医学杂志》
CSCD
2013年第3期365-372,共8页
Chinese Journal of Evidence-based Medicine
关键词
慢性根尖周病变
根管充填术
根管外科
Meta分析
系统评价
随机对照试验
临床对照试验
Chronic periapical lesions
Root canal obturation
Root canal surgery
Meta-analysis
Systematic review
Randomized controlled trial
Controlled clinical trial
