喉全切除术后咽瘘影响因素的Meta分析

目的 系统评价喉恶性肿瘤喉全切除术后咽瘘发生的危险因素.方法 检索MEDLINE、EMBASE数据库和中国生物医学文献数据库、中国学术期刊全文数据库和重庆维普数据库,手工检索所有纳入试验的参考文献,采用RevMan4.2软件对纳入文献的数据进行汇总分析(meta-analysis,Meta分析).结果 共纳入44个临床病例研究,病例总数6917,咽瘘发生例数1004.Meta分析结果显示感染、拔胃管时间、病变部位、术中输血、术前放疗、手术时间、术前气管切开、手术切缘、合并慢性全身性疾病以及T分级与喉全切除术后咽瘘发生有关.结论 感染、拔胃管时间过早或过晚、原发肿瘤部位位于声门上和跨声门区、术中输血、术前放疗、手术时间超过4小时、术前气管切开、手术切缘瘤细胞阳性、合并慢性全身性疾病以及局部晚期肿瘤(T3、T4级)是喉全切除术后咽瘘发生的危险因素.

Meta-analysis of risk factors of pharyngocutaneous fistula after total laryngectomy

OBJECTIVE To evaluate the risk factors of pharyngocutaneous fistula in patients after total laryngectomy. METHODS According to the requirements of Cochrane systematic review, a thorough literature search was performed among MEDLINE, EMBASE, Chinese Digital Hospital Library, Chinese Biomedical Literature Disk Database and Chinese Scientific Journals Database of VIP. Meta analysis was performed on a total of 6917 patients in 44 papers which met the inclusion criteria. Data was analyzed by RevMan4.2 software. RESULTS Local infection, time of oral feeding, surgical margins, concurrent illness, primary tumor site, tumor T stage, preoperative tracheotomy and radiotherapy were related to pharyngocutaneous fistula after total laryngectomy. CONCLUSION Local infection, excessively early or late oral feeding, positive surgical margins, concurrent illness, supraglottic or transglottic tumor, advanced tumor, preoperative tracheotomy and radiotherapy are risk factors of pharyngocutaneous fistula after total laryngectomy.