腮腺手术中应用美容切口与Blair切口比较的系统评价及Meta分析

Cosmetic incision versus Blair incision in parotidectomy:A systematic review and Meta-analysis

目的汇总国内外关于美容切口与Blair切口应用于腮腺手术比较的研究队列,并进行Meta分析,对两种术式的疗效及安全性进行客观的系统性评价。方法检索5种主要的中英文数据库获取相应的文献并进行筛选,检索的时限为数据库建库至2021年9月份。Meta分析采用RStudio 1.4以及R 4.0.2软件进行,其中连续型变量采用加权均数差(Weighted mean difference,WMD),二分类变量采用相对危险度(Relative risk,RR)。异质性小的指标汇总研究时采用固定效应模型,反之则采用随机效应模型。结果共纳入40篇文献(包括42个研究队列),总共有2887例患者,其中实验组1415例,对照组1472例。美容切口相较于Blair切口来说,在术后引流量、切口长度、术后长期并发症率(包括口干、暂时性面瘫、耳周麻木和Frey综合征)以及面部外形评价(包括外观满意率、面部凹陷率、切口美观评分、瘢痕评分以及凹陷评分)方面差异有统计学意义,美容切口预后占优。其余指标两组间差异无统计学意义。结论在腮腺手术中使用美容切口设计相较于传统的Blair切口而言,减少了术后引流量,降低了术后长期并发症的发生率,并大大提高了患者术后外观满意度,推荐在临床上使用。

Objective To summarize research cohorts about the comparison between cosmetic incision and Blair incision applied to parotid gland surgery,and conduct a systematic review and Meta-analysis to evaluate the efficacy and safety of two incisions.Methods Five main Chinese and English databases were retrieved for eligible articles published between their inception and September 2021.Meta analysis was performed using RStudio 1.4 as well as R4.0.2 software,in which the weighted mean difference(WMD)was calculated for continuous data,and the pooled relative risk(RR)was calculated for dichotomous variables.Indicators with low heterogeneity were pooled with the fixed effect model.Otherwise,the random effects model was used.Results A total of 40 literatures(including 42 study cohorts)with a total of 2887 patients,including 1415 in the experimental group and 1472 in the control group,were included.The cosmetic incision was better than the Blair incision in terms of postoperative drainage,incision length,long-term postoperative complication rates(including dry mouth,transient facial paralysis,periauricular numbness,and Frey's syndrome),and facial profile evaluation(including satisfaction rate of appearance,facial concavity rate,aesthetic score of incision,scar score as well as concavity score).There was no significant difference between the two groups in the remaining indicators.Conclusion The use of cosmetic incision design in parotid surgery,compared with the traditional Blair incision,reduces postoperative drainage,decreases the incidence of long-term postoperative complications,and greatly improves the satisfaction of patients'postoperative appearance.Therefore,it is recommended for clinical use.