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

doi:10.6040/j.issn.1673-3770.0.2019.570

摘要/Abstract

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

谭凤武,邓亚萍,黎可华. 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[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 63-71.

TAN Fengwu, DENG Yaping, LI Kehua. The therapeutic effects of low temperature plasma radiofrequency ablation and CO₂ laser surgery on early glottic carcinoma: a Meta-analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 63-71.

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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

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

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