摘要目的 系统评价低温等离子射频消融与CO2激光治疗早期声门型喉癌的疗效。方法 计算机网络检索Web of Science、PubMed、EMbase、中国知网、万方数据和中文科技期刊数据库等,检索时限从数据库建立至2019年7月。搜集比较低温等离子射频消融(射频消融组)和CO2激光(CO2激光治疗组)治疗早期声门型喉癌的相关研究文献,检索词包括早期声门型喉癌、喉癌、喉鳞状细胞癌、等离子、激光手术、经口显微手术,以及 Laryngeal cancer、 radiofrequency ablation、CO2 laser等。完成相关文献的筛选,阅读和文献质量评估,并从中提取手术时间、术中出血量、术后疼痛程度、住院时间和术后黏膜、嗓音恢复情况的研究数据,采用Review Manager 5.3软件进行Meta分析。结果 纳入13篇文献,其中5篇为随机对照试验,8篇为回顾性队列研究;文献质量Newcastle-Ottawa Scale评分结果为8分3篇、7分7篇、6分3篇。共纳入1 110例患者,其中射频消融组584例,CO2激光治疗组526例。Meta分析结果表明,射频消融组患者的手术时间(WMD=-12.97,95% CI -16.69~-9.24, P<0.01)、术后第2天疼痛程度(WMD=-0.09,95% CI -0.17~-0.00, P<0.05)、住院时间(WMD=-1.14,95% CI -2.12~-0.16,P<0.05)、术后1个月黏膜恢复(WMD=-0.28,95% CI -0.48~-0.08, P<0.01)、术后1个月嗓音恢复[Jitter值(WMD=-0.94, 95% CI -1.61~-0.28, P<0.01),Shimmer值(WMD=-1.20,95% CI -1.31~-1.10, P<0.01)]等方面均优于CO2激光治疗组,但CO2激光治疗组在减少术中出血量方面优于低温射频消融组(WMD=0.81,95% CI 0.20~1.43, P<0.05),差异均有统计学意义。结论 在早期声门型喉癌的治疗中,与CO2激光手术相比,低温等离子射频消融手术时间短、术后疼痛轻、住院时间短、术后黏膜恢复和嗓音恢复优,但术中出血多。
Abstract：Objective This meta-analysis aimed to systematically evaluate the efficacy of low-temperature plasma radiofrequency ablation and CO2 laser treatments of early glottic laryngeal cancer.Methods We searched the Web of Science, PubMed, EMbase, CNKI, Wanfang Data, and Chinese science and technology journal databases for relevant studies that compared the efficacy of low-temperature plasma radiofrequency ablation (radiofrequency ablation group) and CO2 laser (CO2 laser treatment group) for the treatment of early glottic laryngeal cancer. The search period was from database establishment to July 2019. The search terms included early glottic laryngeal cancer, laryngeal cancer, laryngeal squamous cell carcinoma, plasma, laser surgery, oral microsurgery, laryngeal cancer, radiofrequency ablation, and CO2 laser. The two co-authors screened relevant literature, assessed its quality, and extracted detailed research data related to surgical time, intraoperative blood loss, postoperative pain, hospital stay, and postoperative mucosal and sound recovery. Review Manager 5.3 software was used for the Meta-analysis.Results Thirteen studies were included, of which five and eight were randomized and retrospective controlled trials, respectively. Newcastle-Ottawa scale scoring results showed 3, 7, and 3 articles with 8, 7, and 6 points, respectively. A total of 1 110 patients were included, including 584 and 526 in the RF ablation and CO2 laser treatment groups, respectively. Meta-analysis revealed that the operation time of patients (WMD=-12.97, 95%CI: -16.69 to -9.24, P<0.01), degree of pain on the second day after operation (WMD=-0.09, 95%CI: -0.17 to -0.00, P<0.05), length of hospital stay (WMD=-1.14, 95%CI: -2.12 to -0.16, P<0.05), mucosal recovery 1 month after operation (WMD=-0.28, 95%CI: -0.48 to -0.08, P<0.01), voice recovery 1 month after surgery [Jitter value (WMD=-0.94, 95%CI: -1.61 to -0.28, P<0.01)], and Shimmer value (WMD=-1.20, 95%CI: -1.31 to -1.10, P<0.01) were better in the RF ablation group than that in the CO2 laser treatment group. However, the CO2 laser treatment group was better than the low-temperature radiofrequency ablation group in reducing intraoperative blood loss (WMD=0.81, 95%CI: 0.20 to 1.43, P<0.05), and the differences were statistically significant.Conclusions Compared with CO2 laser surgery, low-temperature plasma radiofrequency ablation has shorter operation time, less postoperative pain, shorter hospital stay, and better postoperative mucosal recovery and voice recovery but more bleeding during the operation.
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2020, Vol. 25 
