PRISMA-Extracapsular Dissection Versus Superficial Parotidectomy in Treatment of Benign Parotid Tumors: Evidence From 3194 Patients.
PRISMA-Extracapsular Dissection Versus Superficial Parotidectomy in Treatment of Benign Parotid Tumors: Evidence From 3194 Patients.
复制标题
PRISMA-囊外剥离术与腮腺浅表切除术治疗良性腮腺肿瘤的证据来自 3194 名患者
DOI：
10.1097/md.0000000000001237
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发表时间：
2015-08
期刊：
影响因子：
1.6
通讯作者：
Cai ZG
中科院分区：
文献类型：
--
作者：
Xie S;Wang K;Xu H;Hua RX;Li TZ;Shan XF;Cai ZG
腮腺良性肿瘤是头颈部最常见的肿瘤之一。它的治疗方法在过去的100年里一直是有争议的话题。近年来，部分外科医生建议用腮腺囊外剥离术（ECD）代替腮腺浅叶切除术（SP）治疗腮腺良性肿瘤。本研究旨在通过荟萃分析比较ECD和SP治疗腮腺良性肿瘤的效果。我们于2015年2月14日检索了科克伦图书馆、PubMed、Embase、奥维德和Web of Science数据库中评估SP和ECD作为外科技术治疗良性腮腺肿瘤的临床结局的研究。结果数据通过合并风险比（RR）和相应的95%置信区间（CI）进行评价。经过严格审查，共有14项队列研究（3194例患者）纳入本荟萃分析。合并RR显示ECD和SP的肿瘤复发率无显著差异（固定效应模型：RR = 0.71，95%CI = 0.40-1.27，P = 0.249;随机效应模型：RR = 0.67，95%CI = 0.38-1.23，P = 0.197）。 但ECD组患者一过性面神经功能障碍（FND）、永久性FND和Frey综合征的发生率均低于SP组。对于移动的、体积小、位于浅叶、不与面神经粘连的腮腺良性肿瘤，ECD是一种较好的治疗方法，ECD应由有丰富经验、有面神经解剖能力的外科医生进行，术中发现肿瘤与面神经粘连时应行SP术;腮腺良性肿瘤的最佳治疗方案需要多中心随机对照研究。
Benign parotid tumor is one of the most common neoplasms in head and neck region. Its therapeutic methods have been debatable topics over the past 100 years. Recently, some surgeons suggest that extracapsular dissection (ECD) instead of superficial parotidectomy (SP) for treatment of benign parotid tumor. This study aimed to compare ECD with SP in the treatment of benign parotid tumors by a meta-analysis. We searched Cochrane Library, PubMed, Embase, Ovid, and Web of Science databases on February 14, 2015 for studies that assessed clinical outcomes of SP and ECD as surgical techniques for the management of benign parotid tumors. Outcome data were evaluated by pooled risk ratio (RR) and corresponding 95% confidence interval (CI). After serious scrutiny, a total of 14 cohort studies with 3194 patients were included in this meta-analysis. The pooled RR revealed that there were no significant difference in tumor recurrence rate between ECD and SP (fixed-effect model: RR = 0.71, 95% CI = 0.40–1.27, P = 0.249; random-effect model: RR = 0.67, 95% CI = 0.38–1.23, P = 0.197). However, there were significantly lower incidences of transient facial nerve dysfunction (FND), permanent FND, and Frey's syndrome in patients of ECD group compared with SP group. ECD might be a good choice in treatment of the benign parotid tumor that were mobile, small, located in superficial lobe and without adhesion to facial nerve; ECD should be performed by the experienced surgeons with ability of dissection facial nerve, who should perform SP if tumor is found adhere to facial nerve during an operation; and a multicenter randomized control trial study is necessary to decide the optimal treatment of benign parotid tumor.