聚焦超声治疗外阴上皮内非瘤样病变的系统评价

Focused Ultrasound Treatment for Non-neoplastic Epithelial Disorders of Vulva:A Systematic Review

目的评价聚焦超声治疗外阴上皮内非瘤样病变的有效性。方法计算机检索PubMed、Embase数据库、Ovid数据库、中国生物医学文献光盘数据库(CBMdisc)、中国期刊全文数据库(CNKI)、中国科技期刊数据库(VIP)、万方数据库等,查找所有比较聚焦超声和传统方法治疗外阴上皮内非瘤样病变的随机对照试验(RCT)或临床对照试验(CCT)的文献,检索时限均为自建库至2012年9月30日。按纳入、排除标准由2名人员进行文献的筛选、资料提取和质量评价后,采用RevMan 5.1软件进行Meta分析。结果共纳入17篇临床试验,共1 204例患者符合纳入标准。Meta分析结果显示:(1)总有效率:聚焦超声治疗外阴上皮内非瘤样病变与传统对照组比较,临床治疗有效率高,差异有统计学意义(RR=1.64,95%CI:1.38～1.97,P<0.000 01);(2)鳞状上皮增生型有效率:聚焦超声组与传统治疗组相比,差异无统计学意义(RR=1.33,95%CI:0.98～1.79,P=0.06);(3)硬化苔藓型有效率:聚焦超声组相比传统治疗组,差异无统计学意义(RR=1.34,95%CI:0.96～1.87,P=0.08);(4)复发率:聚焦超声组和传统治疗组在复发率方面差异有统计学意义(RR=0.22,95%CI:0.15～0.31,P<0.000 01),传统治疗组高于聚焦超声组。结论聚焦超声相比传统方法治疗外阴上皮内非瘤样病变疗效显著、安全性好,是一种非常有前景的新型治疗方法,值得临床进一步探索及推广。

Objective To evaluate the efficacy of focused ultrasound （FU） therapy in non-neoplastic epithelial disorders of vulva. Methods Databases including the PubMed, EMbase, Chinese Bio-Medieine database, Ovid database, China National Knowledge Infrastructttre, Chinese science and technology periodical database, and Wanfang database were searched, the randomized controlled trials （RCTs） or the controlled clinical trials （ CCTs ） about FUvs conventional method for the therapy of non-neoplastic epithelial disorders of vulva were collected. After study screening, data extraction and quality assessment which were conducted by two independent reviewers, meta-analyses were performed by using the RevMan 5.1 software. Results Seventeen clinical trials involving 1 204 patients were included. Total response rate： compared with the conventional method for the conventional of non-neoplastic dpithelial disorders of vulva, FU was more efficient, and the difference was statistically significant with RR =1.64,95% CI 1.38 to 1.97,P 〈 0.000 01. Squamous epithelial hyperplasia type efficacy：there was no statistieally significant differenee of the efficacy between the conventional control group and FU group （RR = 1.33,95% CI：0.98 to 1.79,P =0.06）. Lichen selemsus of vulva （VLS）：no statistieaUy significant was observed between the conventional control group with FU group with （RR = 1.34,95% CI：0.96 to 1.87,P =0.08）. Relapse rate：compared with the convenfionalcontrol group,FU group had lower re- lapse rate, the difference was statistically significant （RR = 0.22,95% CI：0.15 to 0.31, P 〈 0.000 01 ）. Conclusion The clinical evidence indicates that FU is safer and more efficient in the therapy of non-neoplastic epithelial disorders of vulva, whieh can be a very promising treat- ment and worthy of further exploration and promotion.