發(fā)布時(shí)間：2018-08-18 17:42

【摘要】：目的：對頜面部腫瘤放射治療后頜骨種植體存留的影響因素,包括種植間隔時(shí)間、頜骨位置、放療劑量、高壓氧治療進(jìn)行Meta分析，評估種植體存留的關(guān)聯(lián)因素，為臨床制定治療方案提供參考依據(jù)。 方法：通過計(jì)算機(jī)檢索1980年1月-2013年6月Cochrane圖書館臨床隨機(jī)對照實(shí)驗(yàn)庫、醫(yī)學(xué)文獻(xiàn)分析和檢索系統(tǒng)、荷蘭醫(yī)學(xué)文摘和中國知網(wǎng)數(shù)據(jù)庫、維普數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫,全面收集有關(guān)頜骨放射治療后種植體存留率/失敗率影響因素的相關(guān)文獻(xiàn)。檢索語種為中文和英文。按照Cochrane系統(tǒng)評價(jià)方法，采用種植體失敗率作為指標(biāo)評價(jià)種植間隔時(shí)間、種植頜骨位置、放療劑量、高壓氧治療等影響因素的作用，應(yīng)用Revman5.2軟件，根據(jù)文獻(xiàn)異質(zhì)性檢驗(yàn)結(jié)果，采用固定效應(yīng)模型或隨機(jī)效應(yīng)模型進(jìn)行Meta分析，對結(jié)果進(jìn)行敏感性分析，利用漏斗圖分析各個(gè)研究間的發(fā)表性偏倚。 結(jié)果：根據(jù)文獻(xiàn)納入與排除標(biāo)準(zhǔn)，納入文獻(xiàn)12篇，其中文獻(xiàn)證據(jù)級別為Ib1篇，IIb11篇；證據(jù)強(qiáng)度低等4篇，中等8篇。Meta分析結(jié)果顯示：與放療后種植體失敗率有顯著統(tǒng)計(jì)學(xué)差異的影響因素為：頜骨位置與放療劑量，其合并效應(yīng)量分別為（OR頜骨=12.69，95%CI：4.74-7.56，P0.00001，I2=61%）（OR劑量=0.39、95%CI：0.25-0.62、P0.0001，I2=0%）。種植間隔時(shí)間、高壓氧治療與放療后種植體失敗率間無統(tǒng)計(jì)學(xué)差異，合并效應(yīng)量為（OR時(shí)間=1.27,95%CI:0.95-1.70， P=0.10，I2=22%）、OR高壓氧=1.62（95%CI：0.29-9.0，P=0.58，I2=89%）。對不同影響因素進(jìn)行敏感性分析的結(jié)果顯示，，高壓氧治療影響因素結(jié)果差異較大，顯示該結(jié)果可靠性存疑，其余分析結(jié)果與原結(jié)果相似，認(rèn)為Ｍeta分析結(jié)果穩(wěn)定可靠。 結(jié)論： 1、在頜面部腫瘤患者放射治療后植入種植體，下頜骨比上頜骨、放療劑量小于50Gy比大于50Gy種植存留率更高,有顯著統(tǒng)計(jì)學(xué)差異。 2、種植時(shí)間間隔6-12個(gè)月與大于12個(gè)月的種植存留率差異間無明顯統(tǒng)計(jì)學(xué)意義。 3、尚不能確定高壓氧治療能提高放射治療后頜骨種植體的存留率。 4、Meta分析結(jié)果受原始資料影響，應(yīng)展開更多的高質(zhì)量多中心的隨機(jī)臨床試驗(yàn)，以指導(dǎo)臨床實(shí)踐。
[Abstract]:Objective: to evaluate the relative factors of implant retention in patients with maxillofacial neoplasms after radiotherapy by Meta analysis, including implant interval, maxillary location, radiotherapy dose and hyperbaric oxygen therapy. To provide a reference for clinical treatment. Methods: the clinical randomized controlled experiment database, medical literature analysis and retrieval system, Dutch medical abstract and Chinese knowledge network database, Weip database and Chinese biomedical literature database were searched by computer in Cochrane library from January 1980 to June 2013. A comprehensive collection of relevant literature on the impact of implant survival rate / failure rate after jaw radiotherapy. The search languages are Chinese and English. According to the evaluation method of Cochrane system, the implant failure rate was used as an index to evaluate the effects of implant interval, implant location, radiotherapy dose, hyperbaric oxygen therapy and so on. Revman5.2 software was used according to the results of literature heterogeneity test. The fixed effect model or random effect model was used to analyze the Meta, the sensitivity of the results was analyzed, and the published bias was analyzed by funnel graph. Results: according to the criteria of literature inclusion and exclusion, 12 articles were included, of which 11 were classified as Ib1, and 4 were of low evidence intensity. The results of Meta-analysis showed that there were significant differences in the failure rate of implants between the two groups: the jaw position and the dose of radiotherapy, the combined effect was 12.69% CI: 4.74-7.56% P0.00001P0.00001%) (OR dose of 0.3995 CIW 0.25-0.62P0.000 I 2o 0%). There was no significant difference in the failure rate of implants between hyperbaric oxygen therapy and radiotherapy. The combined effect was (OR time 1.2795 CI: 0.95-1.70, P0. 10% I222%) or hyperbaric oxygen 1.62 (95 CI: 0.29-9.0% P0.58I289%). The results of sensitivity analysis of different influencing factors showed that the results of hyperbaric oxygen therapy were quite different, indicating that the reliability of the results was doubtful, and the other results were similar to the original ones. The results of Meta analysis were considered to be stable and reliable. Conclusion: 1. After radiotherapy in patients with maxillofacial neoplasms, implants were implanted, mandibular bone was higher than maxillary bone, and radiotherapy dose less than 50Gy was higher than 50Gy implantation, the survival rate of implants was higher than that of maxillofacial tumors. There was significant statistical difference. 2. There was no significant difference in implant survival rate between 6-12 months and more than 12 months. 3. It is not certain that hyperbaric oxygen therapy can improve the survival rate after radiotherapy The survival rate of mandibular implants. 4. The results of meta-analysis were affected by the original data. More high-quality multi-center randomized trials should be conducted to guide clinical practice.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.8

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