發(fā)布時間：2018-05-11 06:00

  本文選題：喉癌 + 聲門癌��； 參考：《廣西醫(yī)科大學》2011年碩士論文

【摘要】：目的:人們對早期聲門癌初次選擇的治療方案有爭議。通過本研究,為臨床上早期聲門癌治療方法的選擇提供依據(jù)。 方法:通過電子檢索數(shù)據(jù)庫MEDLINE(1966～2010)、EMBASE (1984～2010)、Cochrane圖書館、中國生物醫(yī)學文獻光盤數(shù)據(jù)庫(1979～2010)、中文學術(shù)期刊全文數(shù)據(jù)庫(1994～2010)、中文科技期刊全文數(shù)據(jù)庫(1989～2010),中文生物醫(yī)學期刊數(shù)據(jù)庫(1994～2010)及萬方數(shù)據(jù)庫。用RevMan5.0計算OR值。 結(jié)果:在XRT vs TOL研究中,在并發(fā)癥發(fā)生率方面,由于納入文獻存在顯著異質(zhì)性,若使用meta分析研究,可能會產(chǎn)生錯誤的結(jié)果,故放棄使用meta分析。在復發(fā)率和5年局部控制率方面,存在較顯著異質(zhì)性,消除異質(zhì)性或采用亞組分析后,體外放射治療(external radiation, XRT)與內(nèi)鏡下激光治療(transoral laser,TOL)差異無統(tǒng)計學意義,但結(jié)果仍傾向于TOL較XRT有更少的復發(fā)和更高的局部控制。而在死亡率、總生存率、喉保留率方面,納入文獻異質(zhì)性較小,進行合并后,得出在這三個方面,內(nèi)鏡下激光治療與放射治療后的結(jié)果相比更具優(yōu)越性。在XRT vs SUR研究中,在復發(fā)率、死亡率、5年總生存率、5年局部控制率方面,納入文獻異質(zhì)性較小,進行合并后,得出在這四個方面,傳統(tǒng)手術(shù)治療(SUR)更具優(yōu)越性,與體外放射治療(XRT)后的結(jié)果相比,差異有統(tǒng)計學意義。在喉保留率方面,納入文獻存在較顯著異質(zhì)性,采用亞組分析后,XRT與SUR差異無統(tǒng)計學意義。在并發(fā)癥發(fā)生率方面,該研究證據(jù)強度低,是否可信有待進一步研究。 結(jié)論:內(nèi)鏡下激光治療的療程簡單,甚至在門診即可完成,而且花費相對便宜,有顯著的優(yōu)越性,故,相比放射治療,激光治療可作為早期聲門癌優(yōu)先選擇的治療方案。但對于腫瘤較大,侵犯前聯(lián)合的患者,還未有明確結(jié)論,根據(jù)文獻資料,建議首選傳統(tǒng)手術(shù)治療。因為本研究中納入的數(shù)據(jù)都是回顧性研究,故需要增加更多的科學、嚴謹?shù)难芯繑?shù)據(jù)或隨機對照試驗結(jié)果才可得出更科學的結(jié)論。
[Abstract]:Objective: the first choice of treatment for early glottic carcinoma is controversial. This study provides evidence for the selection of treatment methods for early glottic carcinoma. Methods: the electronic retrieval database MEDLINE (1966 / 2010) was used to search the EMBASE library, the Chinese Biomedical document CD-ROM database (1979 / 2010), the full text database of Chinese academic journals (1994 / 2010), the full text database of Chinese scientific and technological periodicals (19892010), the Chinese biomedical journal database (1994 / 2010) and the Wanfang database. The OR value was calculated by RevMan5.0. Results: in the XRT vs TOL study, the incidence of complications, because of the inclusion of significant heterogeneity in the literature, if the use of meta analysis may lead to wrong results, so the use of meta analysis was abandoned. There was significant heterogeneity in recurrence rate and 5-year local control rate. After eliminating heterogeneity or using subgroup analysis, there was no significant difference between external radiotherapy (XRTs) and endoscopic laser therapy for transoral laser therapy. But the results still tend to have less recurrence and higher local control in TOL than in XRT. However, the mortality, overall survival rate and laryngeal retention rate were less heterogeneous. After combining, the results of endoscopic laser therapy were more superior than that of radiotherapy. In the XRT vs SUR study, in the aspects of recurrence rate, mortality rate, 5-year overall survival rate and 5-year local control rate, the heterogeneity of literature was small. After combining, it was concluded that the traditional surgical treatment had more advantages in these four aspects. The difference was statistically significant compared with the results after external radiation therapy (XRT). In terms of laryngeal retention rate, there was significant heterogeneity in the included literature. There was no significant difference between XRT and SUR after subgroup analysis. In terms of incidence of complications, the evidence for this study is low, and whether it is credible remains to be further studied. Conclusion: the course of laser therapy under endoscope is simple, even in outpatient service, and the cost is relatively cheap and has obvious advantages. Therefore, laser therapy can be used as a preferential treatment for early glottic carcinoma compared with radiotherapy. However, there is no clear conclusion for the patients with large tumor and pre-invasion. According to the literature, the first choice of traditional surgical treatment is suggested. Since the data included in this study are retrospective studies, more scientific and rigorous research data or results of randomized controlled trials are needed to reach a more scientific conclusion.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.65

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