目的 系统评价手术前玻璃体腔注射bevacizumab(IVB)对增生性糖尿病视网膜病变(PDR)玻璃体切除术的影响.方法 随机对照试验(RCT)的Meta分析.电子检索Medline、Embase、Cochrane图书馆、中国生物医学文献数据库和中国期刊全文数据库,并辅以手工检索.按照纳入和排除标准筛选评价IVB对PDR玻璃体切除术影响的RCT.统计学分析使用Stata/SE 11.2,分析指标包括:手术中出血发生率、手术中眼内电凝使用频次和平均次数、手术时间和手术并发症发生率.结果 共纳入6项符合标准的RCT.结果显示:IVB组手术中出血发生率低于对照组,差异具有统计学意义(P=0.00).IVB组手术中眼内电凝使用频次少于对照组,差异具有统计学意义(P=0.00);IVB组手术中眼内电凝使用平均次数少于对照组,差异具有统计学意义(P=0.00).IVB组手术时间短于对照组,差异具有统计学意义(P=0.00).IVB组手术中医源性视网膜裂孔发生率低于对照组,差异具有统计学意义(P=0.01).结论 手术前IVB能够有效的易化PDR玻璃体切除术,并且降低手术中并发症的发生率,但仍需高质量的多中心、大样本、长期随访的RCT进一步研究证实.%Objective To evaluate the effect of intravitreal bevacizumab (IVB) as a preoperative adjunct in vitrectomy for proliferative diabetic retinopathy (PDR). Methods Meta-analysis of randomized controlled trials (RCTs) was conducted. A computerized search was conducted in the Medline, Embase, Cochrane Library, Chinese Biomedical Database and Chinese Journal Full-text Database combined with manually searching proceedings. RCTs on IVB as a preoperative adjunct in vitrectomy for PDR were selected according to inclusion and exclusion criteria. The statistical analysis was performed by Stata/SE 11.2. The incidence of intraoperative bleeding, frequency and mean number of en-dodiathermy, surgical time and the incidence of intraoperative complications were included in the outcome measures. Results Totally, there were six RCTs that fulfilled the eligibility criteria included in the meta-analysis. The results suggested that:compared with control group,IVB group achieved lower incidence of intraoperative bleeding, less frequency of endodiathermy, less mean number of endodiathermy and less surgical time (P = 0.00). Meanwhile,the incidence of iatrogenic retinal breaks was lower in IVB group than in control group (P = 0.01). Conclusion IVB as a preoperative adjunct in vitrectomy could make the surgery easier for PDR which achieved lower incidence of intraopera- tive complications. However,a high-quality,multicenter,large sample,long-term RCT needs to be further conducted.
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