本文選題：經(jīng)口激光手術(shù) + 放射治療　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)Meta分析的方法,對(duì)比評(píng)估經(jīng)口激光顯微手術(shù)(TLM)和放射治療(RT)對(duì)于早期聲門(mén)型喉癌的臨床療效,為臨床上制定早期聲門(mén)癌的治療方案提供循證學(xué)依據(jù)。方法:通過(guò)PubMed、EMBASE、the Cochrane Library、Web of knowledge、Google Scholarthe、the Wiley online library、中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、中文科技期刊全文數(shù)據(jù)庫(kù)(VIP)檢索有關(guān)激光手術(shù)與放射治療早期聲門(mén)型喉癌的全部文獻(xiàn)。通過(guò)制定納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),對(duì)文獻(xiàn)進(jìn)行篩選、質(zhì)量評(píng)價(jià),選定最終納入研究的文獻(xiàn),并提取相關(guān)評(píng)價(jià)指標(biāo)的數(shù)據(jù)。運(yùn)用RevMan5.3軟件對(duì)數(shù)據(jù)進(jìn)行Meta分析,二分類變量資料采用OR值、95%CI表示效應(yīng)量,以患者的局部復(fù)發(fā)率(LR)、總體生存率(OS)、局部控制率(LC)、喉保存率(LP)、并發(fā)癥發(fā)生率(CR)、死亡率(MR)作為觀察指標(biāo),對(duì)比分析兩種治療方法的療效。結(jié)果:經(jīng)文獻(xiàn)篩選,最終選定18篇符合要求的文獻(xiàn),均為觀察性非隨機(jī)對(duì)照試驗(yàn)。共納入2397個(gè)研究對(duì)象,經(jīng)口激光顯微手術(shù)(TLM)組1165例,放射治療(RT)組1232例。Meta分析結(jié)果顯示:(1)局部復(fù)發(fā)率(LR)的比較:共納入9篇文獻(xiàn),研究對(duì)象1240例,其中TLM組539例,RT組701例。TLM組與RT組的LR無(wú)統(tǒng)計(jì)學(xué)差異[OR=1.04,95%CI(0.72,1.51)Z=0.20,P=0.84]。(2)局部控制率(LC)的比較:共納入14篇文獻(xiàn),研究對(duì)象總計(jì)1830例,其中TLM組876例,RT組954例。TLM組與RT組在腫瘤局部控制方面無(wú)統(tǒng)計(jì)學(xué)意義[OR=1.14,95%CI(0.86,1.51),Z=0.92,P=0.36]。(3)5年總生存率(OS)的比較:共有11篇文獻(xiàn)納入研究,參加病例數(shù)總計(jì)1597例,其中TLM組713例,RT組884例。TLM組與RT組的5年總生存率有統(tǒng)計(jì)學(xué)意義[OR=1.31,95%CI(1.00,1.70),Z=1.97,P=0.05]。(4)喉保存率(LP)比較:共有13篇文獻(xiàn)納入研究,病例數(shù)總計(jì)1995例,其中TLM組977例,RT組1018例。TLM組與RT組在喉器官保存率上有顯著統(tǒng)計(jì)學(xué)差異[OR=4.41,95%CI(2.81,6.94),Z=6.44,P0.00001]。(5)并發(fā)癥(CR)的比較:共有4篇文獻(xiàn)納入研究,病例數(shù)總計(jì)513例,其中TLM組184例,RT組329例。有中度異質(zhì)性,不能合并。通過(guò)敏感性分析,引起異質(zhì)性的研究數(shù)據(jù)來(lái)自Spector JG(1999),并且是權(quán)重最大的文章,去掉其重新Meta分析,結(jié)果顯示:TLM組與RT組在并發(fā)癥發(fā)生率方面沒(méi)有統(tǒng)計(jì)學(xué)意義[OR=0.50,95%CI(0.18,1.40),Z=1.31,P=0.19]。(6)死亡率(MR)的比較:共有8篇文獻(xiàn)納入研究,病例數(shù)總計(jì)1293例,其中TLM組615例,RT組678例。TLM組與RT組的死亡率有統(tǒng)計(jì)學(xué)差異[OR=0.57,95%CI(0.38,0.85),Z=2.77,P=0.006]。結(jié)論:(1)在局部復(fù)發(fā)、腫瘤的局部控制方面,經(jīng)口激光手術(shù)與放射治療可以獲得相似的治療效果。(2)經(jīng)口激光手術(shù)的患者5年總生存率優(yōu)于放射治療,死亡率明顯低于放射治療。(3)經(jīng)口激光手術(shù)的喉保存率高于放射治療。(4)經(jīng)口激光手術(shù)與放射治療在并發(fā)癥發(fā)生率方面無(wú)明顯差異。
[Abstract]:Objective: to evaluate the clinical efficacy of transoral laser microsurgery (TLM) and radiotherapy (RTT) in the treatment of early glottic laryngeal carcinoma by meta-analysis, and to provide evidence based basis for clinical treatment of early glottic carcinoma. Methods: the whole literature on laser surgery and radiotherapy for early glottic laryngeal carcinoma was searched by PubMedine EMBASEN the Cochrane Library of knowledge online the Wiley online library. China knowledge Web, Wanfang Database, Chinese Biomedical Literature Database, Chinese Journal of Science and Technology Full-text Database (VIPs). Through the establishment of inclusion criteria and exclusion criteria, the literature was screened, the quality evaluated, the documents that were included in the study were selected, and the data of relevant evaluation indexes were extracted. The data were analyzed by RevMan5.3 software. The data were classified by OR value (95 CI). The local recurrence rate (LRR), overall survival rate, local control rate (LC), laryngeal retention rate (LPN), complication rate (CRN), mortality rate (MRR) were used as indicators. Compare and analyze the curative effect of two kinds of treatment methods. Results: after literature screening, 18 articles were selected, all of which were observational non-randomized controlled trials. A total of 2397 subjects were included, 1165 cases in the oral laser microsurgery group and 1232 cases in the radiotherapy group. The results of Meta-analysis showed that the local recurrence rate (LRR) was higher than that in the control group: a total of 9 articles were included, and 1240 cases were included in the study. There was no significant difference in LR between TLM group (n = 701) and RT group (n = 701). There was no significant difference in LR between TLM group and RT group. There were 954 cases in TLM group and 954 cases in RT group. There was no significant difference in local tumor control between TLM group and RT group. There were significant differences in 5-year overall survival rate between TLM group (713 cases) and RT group (884 cases). There was significant difference in 5-year survival rate between TLM group and RT group. There were significant differences in the survival rate of laryngeal organs between TLM group (1018 cases) and RT group (1018 cases). There was a significant difference in the survival rate of laryngeal organs between TLM group and RT group (OR4.41 ~ 95CIA 2.81 ~ 6.94 ~ 6.94) (P 0.00001). A total of 4 articles were included in the study, the total number of cases was 513 cases, including 184 cases of TLM group and 329 cases of RT group (n = 329). There is moderate heterogeneity and cannot be combined. By sensitivity analysis, the data that led to heterogeneity came from Spector JGG 1999 and were the most weighted articles, and removed its remeta-analysis. The results showed that there was no significant difference in the incidence of complications between the two groups. There were significant differences in mortality between TLM group (678 cases) and RT group (678 cases). Conclusion (1) in local recurrence and local control of tumor, the curative effect of oral laser surgery and radiotherapy can be similar. 2) the 5-year overall survival rate of patients undergoing oral laser surgery is better than that of radiotherapy. Mortality was significantly lower than that of radiotherapy. 3) the survival rate of larynx in laser surgery was higher than that in radiotherapy. 4) there was no significant difference in the incidence of complications between oral laser surgery and radiotherapy.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.65

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本文編號(hào)：2018538