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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 evaluate the efficacy of different methods (including different root canal surgery and conventional root canal filling, etc.) in the treatment of chronic apical lesions. Methods Computer-based searches were performed using various methods in the Cochrane Library, MEDLINE, EMbase, VIP, CNKI, CBM and WanFang Data including root canal surgery such as apical curettage, reperfusion, apical ablation and conventional root canal filling ) Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) for the treatment of chronic periapical lesions were retrospectively included in the references of the study. The search period was from the database to October 2012. Two researchers independently selected the literature according to the inclusion and exclusion criteria, extracted the data, evaluated the quality and cross-checked it. Meta-analysis was performed using RevMan 5.0 software. Results A total of 7 RCTs and 11 CCTs were enrolled. A total of 1 663 patients were enrolled, including 1 727 teeth. Among them, 1 661 met the inclusion criteria (1 151 in the root canal surgery group and 510 in the conventional treatment group). The methodology used for inclusion in the study is low in quality. Meta-analysis showed that: Overall, different root canal surgery plus root canal filling is superior to simple root canal filling [RR = 1.12,95% CI (1.08,1.18), P <0.000 01]. Subgroup analysis showed that the total effective rate of root canal resection and apical resection were better than that of apical curettage, the difference was statistically significant [RR = 1.3, 95% CI (1.15, 1.46) , P <0.0001; RR = 1.23, 95% CI (1.04, 1.46), P = 0.02]. The effect of root canal resection and apical resection were similar, with no significant difference between the two groups [RR = 0.96 , 95% CI (0.83, 1.11), P = 0.61]. Conclusion The results of this systematic review suggest that root canal filling plus root canal surgery is superior to simple root canal filling in the treatment of chronic apical lesions. Comparing the results of different root canal surgeries, Tube reperfusion surgery are better than apical curettage. Limited by the number and quality of studies involved, combined with root canal filling and root canal surgery, it is difficult to implement operator and patient blindness in clinical practice and there may be measurement bias. Therefore, the above conclusion needs to be carefully studied by high-quality randomized controlled trials verification.