自体脂肪注射治疗单侧声带麻痹的Meta分析

Meta-analysis on autogenous fat injection for unilateral vocal cord paralysis

目的:通过搜索文献对声带内自体脂肪注射(VFAFI)治疗单侧声带麻痹(UVCP)进行系统描述和Meta分析,分析其是否为治疗UVCP有效治疗方式之一。方法:使用相关关键词在PubMed、医知网、维普医学、万方数据、中国医院知识书仓(CHKD)、中国知网(CNKI)等电子数据库进行文献检索。提取的数据包括作者、出版时间、诊断、自体脂肪注射治疗。治疗结果用3个标准来衡量:空气动力学以及频闪喉镜结果、患者自我感觉声音的改变、主客观声学参数。Meta分析根据异质性大小采用固定效应模型或者随机效应模型来分析。结果:5篇文章被纳入研究,共包括404例患者。所有研究都显示患者接受治疗后,各种参数测量结果都有明显提高或降低。电子喉镜与频闪喉镜结果方面,实验组和对照组差异无统计学意义[OR=1.08,95%CI(0.90,1.29)]。患者术后整体自我感觉较好,术后炎症反应轻微,1个月内可消失。标准化噪声能量、频率微扰术后较术前明显降低,实验组与对照组间差异无统计学意义;F0、振幅微扰、最长发声时间术后较术前明显升高,组间差异无统计学意义。结论:VFAFI的损伤性很小,其不良反应可自限。接受治疗的患者主观与客观的声学测量值均有明显提高或降低。进一步的具有更长随访期更大样本的对照研究将会增加VFAFI效力的可信度。

Objective：This study conduct a qualitative synthesis and quantitative meta-analysis of VFAFI,aimed to study whether it is a useful treatment for UVCP.Method：Electronic databases PubMed,YZ365.COM,WANFANG DATA,CMJD,CHKD,CNKI were searched using relevant keywords.Reported treatment outcomes were clustered into three categories,i.e.subjective,perceptual,acoustic,aerodynamic,and stroboscopic.Meta-analyses were performed on studies with numerical results using random effects model.Result：Five articles were identified with a total of 404 patients.All the studies reported significant improvements or decrease after VFAFI in each category of outcome measurements.Meta-analysis demonstrated a significant increase or decrease in all categories.Adverse effects include slight inflammatory reponse can resolve spontaneously within 1month.The recurrence rate after VFAFI was high due to the self absorption.NNE and Jitter of post-operation is lower than pre-operation,there is no significantly change between the control group and experimental group;F0,Shimmer and MPT of post-operation is higher than pre-operation,there is no significantly change between the control group and experimental group.Conclusion：The invasiveness and morbidity of VFAFI are low and the side effects are self-limited.Meta-analyses demonstrated significant improvements or decreased from both objective and subjective measurements.Further controlled studies with longer follow-up periods and more person were included may evaluate the effectiveness of VFAFI more reliably.