腮腺浅叶部分切除术与传统腮腺浅叶切除术治疗腮腺浅叶良性肿瘤效果的meta分析

Efficacy of partial superficial parotidectomy versus superficial parotidectomy for benign neoplasm of superficial parotid gland: meta-analysis

目的 :系统评价腮腺浅叶部分切除术(partial superficial parotidectomy,PSP)与解剖面神经的传统腮腺浅叶切除术(superficial parotidectomy,SP)治疗腮腺浅叶良性肿瘤的疗效及手术并发症,为治疗腮腺浅叶良性肿瘤提供参考。方法:计算机检索Pub Med、EMbase、The Cochrane Library(2015年第4期)、Web of Knowledge、CNKI、CBM、Wan Fang Data和VIP,并辅以检索二次文献;收集关于PSP与SP 2种方法治疗腮腺浅叶良性肿瘤的文献,检索时限从1995年4月至2015年4月。严格执行病例选择及排除标准,独立选择文献,然后评价文献研究方法质量,按照Cochrane手册5.1.0进行文献质量评价,采用Rev Man5.2软件进行meta分析。结果:11篇文献符合纳入标准,共计809例患者。回归分析手术后并发症情况:1暂时性或永久性面瘫的发生率PSP较SP低[RR=0.41,95%CI(0.23,0.72),P=0.002];2涎瘘或积液的发生率PSP较SP低[RR=0.32,95%CI(0.16,0.64),P=0.001];3Frey综合征的发生率PSP较SP低[RR=0.38,95%CI(0.26,0.55),P<0.0001];4面部塌陷或瘢痕畸形的发生率PSP较SP低[RR=0.19,95%CI(0.12,0.31),P<0.0001];5肿瘤复发率:PSP与SP两组差异无统计学意义[RR=0.98,95%CI(0.34,2.86),P=0.98];6耳大神经损伤的发生率PSP较SP低,[RR=0.39,95%CI(0.27,0.58),P<0.0001];7唾液分泌量降低或口干症状的发生率PSP较SP者低,[RR=0.04,95%CI(0.02,0.09),P<0.0001]。结论:与传统SP术式治疗腮腺浅叶良性肿瘤相比,PSP手术时间短,手术并发症少,且不增加肿瘤复发风险。因此,PSP治疗腮腺浅叶良性肿瘤具有一定临床优势,值得推广应用。

PURPOSE： To systematically review the clinical effects and safety of partial superficial parotidectomy（PSP）and superficial parotidectomy（SP） for benign neoplasm of superficial parotid gland. METHODS： We searched Pub Med,EMbase, The Cochrane Library（Issue 4, 2015）, Web of Knowledge 、CNKI、CBM、Wan Fang Data and VIP up to April2015. Randomized controlled trials involving treatment outcomes of benign neoplasm of superficial parotid gland using partial superficial parotidectomy（PSP） compared with superficial parotidectomy（SP） were included.Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Rev Man5.2 software was used for meta analysis. RESULTS： A total of 11 studies involving 809 patients were included. The results of meta analysis showed there were significant differences between PSP group and SP group in transient or permanent facial paresis [RR=0.41, 95%CI（0.23,0.72）, P=0.002], salivary fistula or subcutaneous effusion [RR=0.32, 95%CI（0.16,0.64）, P=0.001], Frey＇s syndrome [RR=0.38, 95%CI（0.26,0.55）, P〈0.0001], facial asymmetry or scar deformity [RR =0.19, 95% CI（0.12,0.31）, P〈0.0001], reduction of salivary flow or xerostomia [RR=0.04, 95%CI（0.02,0.09）, P〈0.0001]; occurrence of great auricular analgesia was significantly less in PSP group than SP group; there was no significant difference in tumor recurrence between the two groups [RR=0.98, 95%CI（0.34,2.86）, P =0.98]. CONCLUSIONS： Compared with SP, PSP does not increase the recurrence rates. Meanwhile,compared with SP, PSP shows lower incidence of postoperative complications in transient or permanent facial paresis,salivary fistula or subcutaneous effusion, Frey＇s syndrome, facial asymmetry or scar deformity, reduction of salivary flow or xerostomia, and great auricular analgesia.PSP is a safe and effective technique for treatment of benign neoplasm of superficial parotid gland with certain advantages over SP, which can be widely applied in clinic.