山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (6): 63-71.doi: 10.6040/j.issn.1673-3770.0.2019.570

• • 上一篇    

低温等离子射频消融与CO2激光手术治疗早期声门型喉癌疗效的Meta分析

谭凤武,邓亚萍,黎可华   

  1. 中南大学湘雅医学院附属株洲医院 耳鼻咽喉头颈外科, 湖南 株洲 412000
  • 发布日期:2021-01-11
  • 通讯作者: 黎可华. E-mail:2729684243@qq.com

The therapeutic effects of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic carcinoma: a Meta-analysis

TAN Fengwu, DENG Yaping, LI Kehua   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, the Affiliated Zhuzhou Hospital of Xiangya School of Medicine CSU, Zhuzhou 412000, Hunan, China
  • Published:2021-01-11

摘要: 目的 采用Meta分析的方法评价支撑喉镜下低温等离子射频消融与CO2激光治疗早期声门型喉癌的临床疗效。 方法 计算机检索PubMed、EMbase、Medline、维普、万方、CNKI数据库。检索年限从建库至2019年5月1日。同时手检纳入文献的参考文献。根据纳入标准和排除标准筛选关于比较支撑喉镜下低温等离子射频消融术与CO2激光手术治疗早期声门型喉癌疗效的文献。由2人单独进行文献的筛选、数据提取及文献的评价,使用Revman 5.3软件进行Meta分析。 结果 共纳入10个研究,1 055例患者。Meta分析结果显示:与CO2激光手术相比,低温等离子射频消融术显著降低了患者的手术时间[SMD=-2.97,95%CI(-4.05,-1.90),P<0.00 001 ]、术后黏膜恢复更快[OR=5.53,95%CI(2.84,10.78), P<0.00 001]、术中出血量更多[SMD=-0.73,95%CI(0.09,0.71),P=0.01],以上两种手术方式相比差异有统计学意义。复发率[OR=0.79,CI95%(0.46,1.36), P=0.39]、术后疼痛程度[SMD=-0.17,95%CI(-0.43,0.08),P=0.18]和术后发声质量[SMD=-0.21,95%CI(-1.13,0.71), P=0.65两种治疗方式相比差异无统计学意义。手术时间及复发率的漏斗图未发现明显发表偏倚。 结论 低温等离子射频消融术治疗早期声门型喉癌在手术时间和术后黏膜恢复方面优于CO2激光手术,但低温等离子射频消融术的术中出血量较多,而复发率、术后疼痛程度和术后发声质量,两种治疗方式相比差异无统计学意义。

关键词: 等离子射频消融术, CO2激光手术, 早期声门型喉癌, Meta分析, 治疗

Abstract: Objective To evaluate the clinical effects of low temperature plasma radiofrequency ablation(LTP-RFA)using a suspension laryngoscope and CO2 laser surgery on early glottic carcinoma by a meta-analysis. Methods Related literature was retrieved from electronic databases, including PubMed, EMbase, Medline, VIP, Wanfang, and CNKI, from inception to June 1st, 2019. At the same time, the reference lists of the enrolled articles were retrieved manually. Literature comparing the therapeutic effects of LTP-RFA using a suspension laryngoscope and CO2 laser surgery on early glottic carcinoma was retrieved according to the inclusion and exclusion criteria. Literature screening, data extraction, and literature evaluation were carried out by two authors independently. Revman 5.3 software was adopted for meta-analysis. Results A total of 10 studies involving 1 055 patients were enrolled. Meta-analysis results suggested that, compared with CO2 laser surgery, LTP-RFA significantly reduced the operative time [SMD =-2.97, 95%CI(-4.05, -1.90), P<0.00 001], shortened the postoperative mucosal recovery time [OR=5.53, 95%CI(2.84, 10.78), P<0.00 001]and increased intraoperative blood loss [SMD=-0.73, 95%CI(0.09, 0.71), P=0.01]. In addition, there were no statistically significant differences in recurrence rate [OR=0.79, 95%CI(0.46, 1.36), P=0.39], degree of postoperative pain [SMD=-0.17, 95%CI(-0.43, 0.08), P=0.18], and postoperative voice quality [SMD=-0.21, 95%CI(-1.13, 0.71), P=0.65] between the two methods. However, sensitivity analysis results revealed that this conclusion may not be robust. No obvious publication bias was detected in the funnel plot regarding the operative time and recurrence rate. Conclusion LTP-RFA has a superior effect over CO2 laser surgery in treating early glottic carcinoma in terms of operative time and postoperative mucosal recovery, but LTP-RFA has greater intraoperative blood. There are no statistically significant differences in recurrence rate, postoperative pain degree, and postoperative voice quality between these two approaches.

Key words: Plasma radiofrequency ablation, CO2 laser, Early glottic carcinoma, Meta-analysis, Therapy

中图分类号: 

  • R765.21
[1] Du LB, Mao WM, Chen WQ, et al. Incidence and mortality of larynx cancer in China during 2003-2007[J]. Zhonghua Liuxingbingxue Zazhi, 2012, 33(4): 395-398. PMID: 22781413.
[2] Hoffman HT, Porter K, Karnell LH, et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival[J]. Laryngoscope, 2006, 116(9 Pt 2 Suppl 111): 1-13. doi:10.1097/01.mlg.0000236095.97947.26.
[3] 季文樾, 杜强, 关超, 等. 1115例喉癌患者的生存分析[J]. 中华耳鼻咽喉科杂志, 2004, 39(1): 17-19. doi: 10.3760/j.issn:1673-0860.2004.01.005. JI Wenyue, DU Qiang, GUAN Chao, et al. Survival analysis of 1115 patients with laryngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology, 2004, 39(1): 17-19. doi: 10.3760/j.issn:1673-0860.2004.01.005.
[4] O'Hara J, Markey A, Homer JJ. Transoral laser surgery versus radiotherapy for tumour stage 1a or 1b glottic squamous cell carcinoma: systematic review of local control outcomes[J]. J Laryngol Otol, 2013, 127(8): 732-738. doi:10.1017/S0022215113001400.
[5] van Loon Y, Sjögren EV, Langeveld TPM, et al. Functional outcomes after radiotherapy or laser surgery in early glottic carcinoma: a systematic review[J]. Head Neck, 2012, 34(8): 1179-1189. doi:10.1002/hed.21783.
[6] American Society of Clinical Oncology, Pfister DG, Laurie SA, et al. American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer[J]. J Clin Oncol, 2006, 24(22): 3693-3704. doi:10.1200/JCO.2006.07.4559.
[7] Stuart Strong M. Laser excision of carcinoma of the larynx[J]. Laryngoscope, 1975, 85(8): 1286-1289. doi:10.1288/00005537-197508000-00003.
[8] Brndbo K, Benninger MS. Laser resection of T1a glottic carcinomas: results and postoperative voice quality[J]. Acta Otolaryngol, 2004, 124(8): 976-979. doi:10.1080/00016480410017413.
[9] Timms MS, Bruce IA, Patel NK. Radiofrequency ablation(coblation): a promising new technique for laryngeal papillomata[J]. J Laryngol Otol, 2007, 121(1): 28-30. doi:10.1017/S0022215106003069.
[10] Carney AS, Evans AS, Mirza S, et al. Radiofrequency coblation for treatment of advanced laryngotracheal recurrent respiratory papillomatosis[J]. J Laryngol Otol, 2010, 124(5): 510-514. doi:10.1017/S00222151099-92398.
[11] 张庆丰, 刘得龙, 宋伟, 等. 等离子射频消融术治疗早期声门型喉癌的疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2011, 25(18): 855-856. doi:10.3969/j.issn.1001-1781.2011.18.013.
[12] 陈刚, 赵华, 荆建军, 等. 显微支撑喉镜下等离子消融治疗早期声门型喉癌11例[J]. 山东大学耳鼻喉眼学报, 2012, 26(4): 24-26. doi: CNKI:SUN:SDYU.0.2012-04-010. CHEN Gang, ZHAO Hua, JING Jianjun, et al. Glottic carcinoma at early stage treated by microscopic suspension laryngoscopy combined with a coblation technique: a report of 11 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2012, 26(4): 24-26. doi: CNKI:SUN:SDYU.0.2012-04-010.
[13] 刘敏, 牛广宪. 低温等离子射频消融术治疗早期声门型喉癌疗效分析[J]. 听力学及言语疾病杂志, 2015, 23(4): 422-423. doi:10.3969/j.issn.1006-7299.2015.04.024.
[14] 徐夏, 邓文婷, 黄成志, 等. 喉内镜下等离子消融术与开放性手术治疗早期喉癌的疗效对比[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 81-85. doi: CNKI:SUN:SDYU.0.2019-02-017. XU Xia, DENG Wenting, HUANG Chengzhi, et al. Curative effect analysis of endoscopic laryngeal surgery with plasma radiofrequency ablation versus open surgery to treat early glottic cancer[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 81-85. doi: CNKI:SUN:SDYU.0.2019-02-017.
[15] Shuang Y, Li C, Zhou X, et al. Outcomes of radiofrequency ablation(RFA)and CO2 laser for early glottic cancer[J]. Am J Otolaryngol, 2016, 37(4): 311-316. doi:10.1016/j.amjoto.2016.03.002.
[16] Zhang Y, Wang BR, Sun GB, et al. Carbon dioxide laser microsurgery versus low-temperature plasma radiofrequency ablation for T1a glottic cancer: a single-blind randomized clinical trial[J]. Biomed Res Int, 2018, 2018: 4295960. doi:10.1155/2018/4295960.
[17] 信鑫. 微创手术治疗早期声门型喉癌及癌前病变的近期疗效观察[D]. 长春: 吉林大学, 2013.
[18] 周天骄. 等离子射频消融手术对早期声门型喉癌的疗效[D]. 上海: 上海交通大学, 2014.
[19] 周津徽,王成禹. CO2激光和等离子射频消融术应用于早期声门型喉癌治疗中对相关手术指标、疼痛及复发情况的影响[J]. 中国全科医学, 2018, 21(z1): 200-202. doi: 10.3969/j.issn.1007-9572.2018.z1.085. ZHOU Jinhui, WANG Chengyu. Effects of CO2 laser and plasma radiofrequency ablation on related surgical indexes, pain and recurrence in the treatment of early laryngeal cancer[J]. Chinese General Practice, 2018, 21(z1): 200-202. doi: 10.3969/j.issn.1007-9572.2018.z1.085.
[20] 李毅, 王克. 内镜下低温等离子射频消融术治疗早期声门型喉癌的临床观察[J]. 肿瘤基础与临床, 2018, 31(1): 71-73. doi:10.3969/j.issn.1673-5412.2018.01.023.
[21] 胡莲花. 比较CO2激光与等离子射频消融术治疗早期声门型喉癌的疗效[J]. 按摩与康复医学, 2016, 7(22): 36-37.
[22] 赵斐斐, 赵琳, 崔晓波, 等. 低温等离子与CO2激光微创治疗早期声门型喉癌疗效及安全性比较[J]. 现代生物医学进展, 2016, 16(36): 7087-7090. doi:10.13241/j.cnki.pmb.2016.36.022. ZHAO Feifei, ZHAO Lin, CUI Xiaobo, et al. Comparison of efficacy and safety of microtherm plasma radio frequency and CO2 laser in treatment of early glottic squamous cell carcinoma[J]. Progress in Modern Biomedicine, 2016, 16(36): 7087-7090. doi:10.13241/j.cnki.pmb.2016.36.022.
[23] 赵春红, 李玉杰, 于敏, 等. CO2激光与等离子射频消融术治疗早期声门型喉癌疗效比较[J]. 听力学及言语疾病杂志, 2015, 23(3): 307-309. doi: 10.3969/j.issn.1006-7299.2015.03.0023.
[24] 陈柯帆, 黄义, 任丽君. 低温等离子射频消融术及CO2激光治疗早期喉癌及癌前病变效果比较[J]. 现代仪器与医疗, 2018, 24(3): 17-19. doi:10.11876/mimt201803008. CHEN Kefan, HUANG Yi, REN Lijun. Effect comparison of low-temperature plasma radiofrequency ablation and CO2laser surgery in the treatment of early laryngeal carcinoma and precancerous lesions[J]. Modern Instruments &Mediccal Treatment, 2018, 24(3): 17-19. doi:10.11876/mimt201803008.
[25] 李为民, 王荣光, 黄冬雁, 等. 低温等离子射频消融术治疗喉部恶性肿瘤的临床疗效[J]. 中国老年学杂志, 2015, 35(6): 1449-1451. doi: 10.3969/j.issn.1005-9202.2015.06.005. LI Weimin, WANG Rongguang, HUANG Dongyan, et al. The efficacy of transoral coblation microsurgery for laryngocarcinoma[J]. Chinese Journal of Gerontology, 2015, 35(6): 1449-1451. doi: 10.3969/j.issn.1005-9202.2015.06.005.
[26] 张诠, 欧阳电. 喉癌显微激光手术学的发展及其制约因素[J]. 中华临床医师杂志(电子版), 2012, 6(2): 285-287. doi:10.3877/cma.j.issn.1674-0785.2012.02.003.
[27] Motta G, Esposito E, Cassiano B, et al. T1-T2-T3 glottic tumors: fifteen years experience with CO2 laser[J]. Acta Otolaryngol Suppl, 1997, 527: 155-159. doi:10.3109/00016489709124062.
[28] Thomas JV, Olsen KD, Neel HB 3rd, et al. Early glottic carcinoma treated with open laryngeal procedures[J]. Arch Otolaryngol Head Neck Surg, 1994, 120(3): 264-268. doi:10.1001/archotol.1994.01880270012003.
[29] Tsunoda K, Soda Y, Tojima H, et al. Stroboscopic observation of the larynx after radiation in patients with T1 glottic carcinoma[J]. Acta Otolaryngol Suppl, 1997, 527: 165-166. doi:10.3109/00016489709124064.
[30] Hartl DM, Brasnu DF. Contemporary surgical management of early glottic cancer[J]. Otolaryngol Clin North Am, 2015, 48(4): 611-625. doi:10.1016/j.otc.2015.04.007.
[31] Moustapha S, Olivier D, Alexandre B, et al. Laser endoscopic microsurgery of laryngeal cancers[J]. Int Arch Otorhinolaryngol, 2014, 18(1): 36-38. doi:10.1055/s-0033-1361084.
[32] Carney AS, Timms MS, Marnane CN, et al. Radiofrequency coblation for the resection of head and neck malignancies[J]. Otolaryngol Head Neck Surg, 2008, 138(1): 81-85. doi:10.1016/j.otohns.2007.08.022.
[33] Remacle M, Eckel HE, Antonelli A, et al. Endoscopic cordectomy. A proposal for a classification by the working committee, European laryngological society[J]. Eur Arch Otorhinolaryngol, 2000, 257(4): 227-231. doi:10.1007/s004050050228.
[1] 张静祎,王文一,荣凌燕,张家奎,宋西成. 中药热奄包外敷联合七叶皂苷钠静滴治疗鼻部外伤肿胀疗效观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 21-26.
[2] 敬前程,龚巍,周定刚,周芳. 咽部放线菌病6例临床分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 54-57.
[3] 杨军, 郑贵亮. 外周前庭疾病的诊断和治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 1-6.
[4] Fahad Alkherayf, Hussein Kheshaifati, Abdulhadi Algahtani, Santanu Chakraborty, David Schramm. 上半规管裂综合征[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 89-96.
[5] 任雨馨综述赵博军审校. 病理性近视脉络膜新生血管的诊断与治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 157-162.
[6] 杨明综述魏文斌审校. 溶栓治疗在视网膜动脉阻塞中的应用进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 5-10.
[7] 王露萍综述黄映湘, 王艳玲审校. 眼缺血综合征研究进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 23-27.
[8] 陈曦, 李珊珊, 赵露, 尤冉, 王艳玲. 动脉溶栓治疗视网膜中央动脉阻塞Meta分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 28-34.
[9] 王莹莹,张立庆,周涵,董诗坤,陈海兵,陈曦,董伟达. 74例鳃裂囊肿及瘘管临床分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 111-116.
[10] 周芳茗,谢艳,刘洋综述蒋路云审校. 鼻源性头痛的研究动态分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 130-133.
[11] 潘新良. 加强甲状腺结节及恶性肿瘤的规范治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 1-12.
[12] 青晓艳, 徐义全综述李超审校. 甲状腺未分化癌的分子机制研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 26-31.
[13] 夏同良, 魏东敏, 钱晔, 李文明, 季炜, 潘新良, 雷大鹏. 累及喉、气管的甲状腺乳头状癌临床治疗分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 46-51.
[14] 徐进敬,胡京华,吴元庆,邓毅,喻唯唯. CO2激光显微手术在喉癌前病变和早期声门型喉癌中的应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 129-133.
[15] 林晓芹综述吴苗琴审校. 特发性视网膜前膜的发病机制及治疗进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 121-128.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!