营养支持对喉癌术后咽瘘影响的Meta分析

doi:10.6040/j.issn.1673-3770.0.2022.283

摘要/Abstract

摘要： 目的系统评价营养支持对喉癌术后咽瘘的影响,为预防或减少喉癌术后咽瘘发生提供依据。方法系统检索Pubmed、Embase、Cochrane Library、Web of Science、CNKI、万方、维普、中国生物医学文献数据库,收集从建库至2022年6月国内外发表的关于营养支持对咽瘘影响的相关原始研究,使用Cochrane偏倚风险评价工具对纳入的文献进行质量评价并使用Revman 5.4.1软件制作偏倚风险评价图,对纳入的文献进行数据提取,对所提取数据使用Revman 5.4.1软件进行效应量的合成,并生成森林图,根据分析结果中的Chi²及I2值判断纳入文献的异质性,对于结局指标,使用GRADEprofiler 3.6 软件进行证据质量评级,使用Stata15.1 软件作Begg's漏斗图与Egger's test。结果森林图以OR为指标,OR=0.37,95%CI:0.27~0.52,上下限均位于基线1的左侧,与基线无相交,异质性分析结果P=0.97,I2=0,GRADE评级为MODERATE,Begg's漏斗图与Egger's检验表明漏斗图对称可能性小,可能存在发表偏移(T=-2.85,P=0.019),故采用剪补法进行调整,调整后的OR=0.42,95%CI:0.30~0.58。结论森林图结果支持营养支持能够预防并减少喉癌术后咽瘘的发生,采用剪补法调整后OR值变化不明显,异质性分析显示纳入文献具有良好同质性,能够进行效应量的合成,营养支持可以作为预防喉癌一个重要的预防手段,减少喉癌术后咽瘘的发生。

关键词: 营养支持, 喉癌, 咽瘘, 围手术期, Meta分析

Abstract: Objective To systematically evaluate the influence of nutritional support on pharyngeal fistula after laryngeal cancer surgery and to provide support for preventing or reducing the onset of pharyngeal fistula after laryngeal cancer surgery. Methods The relevant original studies on nutritional support for pharyngeal fistula that were published in China and abroad from were collected by systematically retrieving Pubmed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP and sinoMed database articles, up to June 2022. The Cochrane bias risk assessment tool was used to carry out the quality assessment on the included literature and Revman 5.4.1 software was used to produce a bias risk assessment diagram for data extraction from the included literature. Revman 5.4.1 software was used to synthesize the effectors of the extracted data and generate a forest plot. According to the Chi² and I2 values of the analysis results, the heterogeneity of the included literature was judged. In view of outcome indicators, GRADEprofiler 3.6 software was used for evidence quality grading, and Stata15.1 software was used for Begg's funnel plot and Egger's test analyses. Results In the forest plot, with OR as the indicator(OR=0.37, 95% CI: 0.27-0.52), the upper and lower limits were located on the left side of baseline 1 and did not intersect with the baseline. In terms of the heterogeneity of the analysis results, P=0.97, I2=0, GRADE: MODERATE. Begg's funnel plot and Egger's test showed that there was little funnel plot symmetry, with potential publication offset(T=-2.85, P=0.019). Thus, the adjustment shall be carried out using the trim and filling method. After adjustment, OR=0.42, 95% CI: 0.30-0.58. Conclusion The forest plot results support that nutritional support can prevent and reduce the onset of pharyngeal fistula after laryngeal cancer surgery. The OR value does not change significantly after being adjusted using the trim and filling method. The heterogeneity analysis shows that the included literature has good homogeneity and is suitable for the synthesis of effectors. Nutritional support can be adopted as an important prevention measure for preventing laryngeal cancer, so as to reduce the onset of pharyngeal fistula after laryngeal cancer surgery.

Key words: Nutritional support, Laryngeal cancer, Pharyngeal fistula, Perioperative period, Meta analysis

中图分类号:

R739.6

张西,邓启成,张震,程瑶,王靖淞,赵锐,刘海. 营养支持对喉癌术后咽瘘影响的Meta分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 51-59.

ZHANG Xi, DENG Qicheng, ZHANG Zhen, CHEN Yao, WANG Jingsong, ZHAO Rui, LIU Hai. Effect of nutritional support on postoperative pharyngeal fistula after laryngeal cancer surgery: a Meta-analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(3): 51-59.

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