T1a声门型喉癌患者激光和放射治疗后嗓音功能评估文献的Meta分析

A Comparative Assessment of Voice after Laser Surgery Versus Radiotherapy of T1a Glottic Carcinoma:A Meta-Analysis

目的通过对相关文献的Meta分析,评估T1a声门型喉癌患者激光手术和放射治疗后的嗓音功能。方法通过计算机检索PubMed、Web of Science、Embase数据库、Cochrane library、中国知网数据库及万方数据库从创建到2016年10月的文献数据,纳入比较T1a声门型喉癌患者激光手术和放射治疗后的嗓音功能评估随机对照研究和队列研究文献,由两位共同作者同时对搜索的相关文献进行阅读和筛选,从中提取与研究目的相关的数据,用Review Manager 5.3软件进行Meta分析,分析和比较两种方式治疗后患者VHI评分、最长发声时间(MPT)、基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、气流量(AFR)。结果共检索相关文献182篇,共纳入符合要求的文献14篇,均为队列研究,共有716例患者,其中行激光手术的患者391例,行放射治疗患者325例。Meta分析结果表明,激光手术组患者术后最长发声时间(MPT)比放射治疗组短[总效应Z=2.65,MD=-2.26,95%CI(-3.94,-0.59),P=0.008],基频(F0)较放射治疗组低[总效应Z=7.49,MD=14.41,95%CI(10.14,18.19),P<0.00 001],两种方式治疗后患者的VHI评分[总效应Z=1.04,MD=5.86,95%CI(-5.22,16.94),P=0.30]、jitter[总效应Z=1.43,MD=0.75,95%CI(-0.28,1.79),P=0.15]、shimmer[总效应Z=1.26,MD=1.07,95%CI(-0.60,2.75,P=0.21]及AFR[总效应Z=0.42,MD=21.46,95%CI(-78.79,121.72),P=0.67]差异均无统计学意义。结论在保护T1a声门型喉癌患者嗓音功能(MPT、F0)方面放射治疗稍优于激光手术,但两种方式治疗后患者嗓音障碍指数量表、基频微扰、振幅微扰及气流量差异均无统计学意义。

Objective To carry out a Meta-analysis on the published data to evaluate voice after laser surgery versus radiotherapy of T1 aglottic carcinoma.Methods The major medical-related databases were used in this study including PubMed,Web of Science,Embase,Cochrane library,CNKI and Wanfang Date.The articles by two co-authors at the same time were screened to read the relevant literatures,extraction of data and research related to the purpose from the selected literature.Results According the necessary conditions,fourteen literatures was included finally,and statistical analysis results showed that owing to the meta-analysis of the maximum time of speech（MPT）[test for overall effect：Z=2.65,MD=-2.26,95%CI（-3.94,-0.59）,P=0.008]and the fundamental frequency（F0）[test for overall effect：Z=7.49,MD=14.41,95%CI（10.14,18.19）,P〈0.000 01],radiation therapy was superior to laser surgery,but the Meta-analysis of voice handicap index（VHI）[test for overalleffect：Z=1.04,MD=5.86,95%CI（-5.22,16.94）,P=0.30],jitter[test for overall effect：Z=1.43,MD=0.75,95%CI（-0.28,1.79）,P=0.15],shimmer[test for overall effect：Z=1.26,MD=1.07,95%CI（-0.60,2.75,P=0.21]and Airflow rate（AFR）[test for overall effect：Z=0.42,MD=21.46,95%CI（-78.79,121.72）,P=0.67]don＇t show statistically significant difference between the two groups.Conclusion The radiation therapy is slightly superior to the laser surgery in protecting voice in the treatment of T1 aglottic carcinoma.