环舌骨会厌吻合术和喉次全切除会厌喉成形术治疗早期声门型喉癌文献的Meta分析

摘要

目的 通过文献分析,比较环舌骨会厌吻合术与喉次全切除会厌喉成形术治疗早期声门型喉癌的疗效,为喉癌治疗方式选择提供循证医学依据.方法 计算机联机检索Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库以及中文科技期刊全文数据库所有文献,纳入有关环舌骨会厌吻合术与喉次全切除会厌喉成形术治疗早期声门型喉癌的临床对照试验,应用RevMan 5.1统计软件分析评价两种术式的5年生存率、病变复发率、术后气管套管拔除时间及鼻饲管拔除时间.结果 最终纳入2个回顾性非随机临床对照试验,质量为B级.Meta分析显示,与环舌骨会厌吻合术相比较,喉次全切除会厌喉成形术后鼻饲管拔除时间较短,但其余指标两组之间无统计学意义.结论 从目前的有限证据看,早期声门型喉癌的常用手术疗法并无明显的疗效优势差别.%Objective To evaluate the long-term therapeutic effect of surgical therapies on glottic carcinoma at early stage baseS on a literature study, with the focus on the efficacy comparison between rico-hyo-epiglottopexy and subtotal laryngectomy combined with epiglottis-laryngoplasty. Methods A literature study was earned out through online search for the literatures, designed on the basis of randomized controlled trials about crico-hyo-epiglottopexy and subtotal laryngectomy combined with epiglottis-laryngoplasty for glottic carcinoma at early stage, from such databases as Medline, Cochrane Library, EMBASE, CBM, CNKI and VIP. This study was focused on five-year survival rate, local lesion recurrence rate, averaged trachea decannulan'on time and nasal feeding tube removal time following the operation, and Meta-analysis was performed to evaluate these results by use of RevMan 5.1 software. Results Two retrospective non-randomized trials fulfilled inclusion criteria at the quality level of graded B. When compared with crico-hyo-epiglottopexy, subtotal laryngectomy combined with epiglottis-laryngoplasty was shown with shortened nasal feeding tube removal time (SMD=0.97, 95%CI=-0.02-1.97,P=0.04). However, there were no significant differences in other indicators as five-year survival rate (OR=0.80, 95%CI=0.19-3.45, P=0.45), recurrence rate (OR=0.37,95%CI=0.08-1.64, P=0.27) and mean trachea decannulation time (SMD=0.29, 95%CI=-0.16-0.73, P=0.77) between these two kinds of surgical procedures. Conclusions Based on these limited evidences, it seems that there are no particular superiors for the therapeutic effects of various kinds of surgical procedures routinely used in present clinical practice on glottic carcinoma at early stage.