腮腺良性肿瘤手术保留耳大神经临床价值Meta分析

Clinical significance of preserving the great auricular nerve in parotidectomy:A Meta-analysis

目的：通过Meta分析评价腮腺良性肿瘤切除术中保留耳大神经（greatauricularnerve，GAN）对术后各并发症发生率影响，探讨其临床价值。方法：以腮腺、耳大神经、并发症等为关键词对1997-04-2013-04期间PubMed、万方数据库等进行中英文文献检索，根据纳入及排除标准对纳入研究采用RevMan5．0软件包进行荟萃分析。结果：12项涉及术后耳廓区暂时性感觉异常的研究中，共有366例出现症状，总发生率为50．76％，实验组（保留耳大神经）113例占27．56％，对照组（切除耳大神经）253例占81．35％，实验组较对照组的发生率降低53．79％，比值比（OR）及其95％置信区间（95％CI）为0．09（0．06～0．13），z=11．99，P〈0．01；6项关于术后味觉出汗综合征发生率的研究中，共74例出现症状，占总例数18．73％，实验组15例占7．50％，对照组59例占30．26％，前者较后者低22．76％，0R及其95％CI为0．18（0.10～0．35），z=5．18，P〈0．01；13项涉及影响生活质量并发症的研究中，243例出现不同症状，占总例数的31．93％，实验组62例占14．22％，对照组181例占55．69％，前者显著降低了41．47％，0R值及其95％CI为0．12（0．08～0．18），z=10．77，P〈0．01。结论：腮腺良性肿瘤手术能够对GAN进行功能保全，其不仅能够降低术后耳廓区暂时性感觉异常和味觉出汗综合征发生率，还能对其他影响生活质量的并发症加以控制，改善患者术后生活质量。

OBJECTIVE： To evaluate the influence of parotidectomy that retained great auricular nerve on postoperative morbidity by meta-analysis,and to explore its clinical value. METHODS.- A literature search was performed using the PubMed, Wanfang database and other databases from April 1997 to April 2013 by parotid,great auricular nerve, complications as keywords. The included studies using Review manager 5.0 software for meta-analysis according to the inclusion and exclusion criteria. RESULTS： In the 12 articles involved with the postoperative sensory disturbance, 366 cases had symptoms the overall incidence rate was 50. 76%. In experimental group （preserve great auricular nerve） there were 113 cases and accounted for 27.56%. In the control group （removal of great auricular nerve） there were 253 cases and accounted 81.35 %. The incidence of sensory disturbance in experimental group was decreased by 53.79% compared with control group,odds ratio （OR） and 95% confidence intervals （95%CD was 0. 09（0. 06-0.13） ,z was 11.99,P〈0.01; 6 articles involved with gustatory sweating syndrome, symptoms in 74 cases accounted for. 18.73 % of the total number of cases,15 cases were in experimental group and accounted for 7.50%, 59 cases were in control group and accounted for 30.26%,the former was lower than the latter by 22.76%. OR values and their 95%CI was 0.18（0.10-0. 35）,z value was 5.18,P〈0.01;13 studies involved complications which affect the quality of life. There were different symptoms of complications in 243 cases, The overall incidence rate was 31. 93%. The experimental group of 62 cases accounted forfor 14.22%, in the control group 181 cases accounted for 55. 69%, In experiment group it was significantly reduced by 41.47 % ; OR values and 95 0% CI was 0.12 （0.08 - 0. 18）, z was 10.77, P〈0.01. CONCLUSION ： Benign parotid surgery through rational selection and operation, can really preserve GAN, which not only can reduce the incidence of postoperative transient paresthesia auricular region and gustatory sweating syndrome,hut also control other complications thereby to improve the quality of life for patients after surgery.