保留腮腺咬肌筋膜预防Frey综合征的系统评价与Meta分析

A systematic review and Meta-analysis of effects of parotid masseteric fascia reservation on prevention of Frey's syndrome

目的通过系统评价和Meta分析的方法评估腮腺切除手术中保留腮腺咬肌筋膜对于预防术后Frey综合征的有效性及安全性。方法采用主题词检索策略,电子检索Pubmed、EMBase、Cochrane临床随机对照试验数据库、中国生物医学文献数据库、中国知网、维普数据库、万方数据库,检索时间截止至2013年3月30日。2位评价员按照Cochrane协作网推荐的方法和标准,对纳入的文献提取数据,并独立进行偏倚风险评价,并进行系统评价。运用Review manager 5.2进行Meta分析。结果共纳入随机对照试验13篇,偏倚风险不清。Meta分析结果显示:保留腮腺咬肌筋膜能够减少81%的主观Frey综合征的发生率(P<0.000 01),能够减少69%的客观Frey综合征的发生率。患者术后复发情况的Meta分析结果显示:两组患者术后复发情况没有统计学差异(P=0.47)。结论保留腮腺咬肌筋膜能够明显降低患者术后Frey综合征的发生,具有良好的有效性和安全性,而且术后复发情况无差异。

Objective To evaluate the effects and safety of parotid masseteric fascia（PMF） reservation during parotidectomy for the prevention of Frey’s syndrome by the method of systematic review and Meta-analysis. Methods Pubmed, EMBase, CENTRAL, Chinese BioMedicine on disc, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals and Wanfang database were searched electrically on 30 March 2013. Two reviewers extracted data and assessed the risk of bias independently with the criteria introduced by Cochrane Collaboration. Meta-analysis was done with Review Manager 5.2. Results Thirteen randomized controlled trials were included and all of them had risk of bias. The outcomes of Meta-analysis showed that PMF reservation reduced 81% Frey’s syndrome on subjective diagnostic criteria（P〈0.000 01）, and 69% on objective diagnostic criteria. And the Meta-analysis on tumor recurrence showed that there was no significant difference between two groups（P=0.47）. Conclusion Reserving PMF reduced the Frey’s syndrome after paretidectomy remarkably, and had no difference on recurrence rate, which implied great effect and safety.