超声刀在颈清扫术中有效性及安全性的Meta分析

Efficacy and safety of harmonic scalpel in neck dissection:a Meta-analysis

目的:系统评价超声刀在颈清扫术中有效性及安全性。方法:检索PubMed、EMBASE、Cochrane Library、Google Scholar、中国生物医学文献数据库、中国知网、万方及维普数据库2014年6月之前比较超声刀与传统手术的研究,进行文献质量评价,对符合标准的文献提取相关效应指标,应用RevMan5.2软件进行Meta分析。结果:9项随机对照研究和5项非随机对照研究共计632例病例纳入研究,其中超声刀组319例,传统手术组313例。与传统手术组相比,超声刀组手术时间短,加权均数差(WMD)及其95%可信区间(95%CI)为-28.01(-36.83^-19.19),Z=6.22,P<0.01;术中出血量少(WMD及其95%CI为-46.68(-57.25~36.12),Z=8.66,P<0.01;颈部淋巴结清扫个数、术后乳糜漏发生率2组相似,差异无统计学意义。结论:超声刀能缩短颈清扫术中的手术时间,减少出血量,而对颈部淋巴结清扫个数及术后乳糜漏发生率无影响,是有效、安全、可行的。

Objective： To systematically evaluate the efficacy and safety of harmonic scalpel in neck dissection. Method： Available literatures of PubMed, EMBASE, Coehrane Library, Google Scholar, CBM, CNKI, WangFang and VIP published before June 2014 were searched. Inclusion criteria and quality assessment were performed. All data were analyzed by using RevMan 5.2 software. Result.. Fourteen studies including 632 cases were enrolled. Among them, 319 cases were in harmonic scalpel group and 313 Cases in conventional resection group. Compared with conventional resection group, the harmonic scalpel group showed shorter surgery time（weighted mean difference [95 X confidence intetval] - 28. 01[-36.83, - 19. 19], Z= 6.22, P〈0. 01） and less intra-operative blood loss （weighted mean difference [- 95 G confi- dence intetval] ： -46.68[-57.25,-36. 12] ,Z=8. 66,P〈0.01）. The number of cervical lymph nodes dissected and the incidence of postoperative chylous leakage were similar in both groups. Conclusion： Using the harmonic scalpel in neck dissection was as efficient and safe as that of the conventional technique with the advantage of shorter time of surgery and less intraoperative blood loss.