摘要：

目的： 系统评价内镜手术和传统手术治疗下颌下腺良性肿瘤的临床疗效。方法： 按照检索策略在中国知网、中国生物医学文献数据库、维普、万方、PubMed、EMBase、Cochrane library数据库检索相关文献，检索时间截至2024年1月1日。由2位评价员独立按照纽卡斯尔-渥太华量表（Newcastle-Ottawa scale，NOS）对纳入文献进行质量评价，并进行Meta分析。结果： 共纳入9篇文章，1篇随机对照试验（randomized controlled trial，RCT），8篇非随机对照试验（non-randomized controlled trial，nRCT），涉及356例患者，其中内镜组153例，传统手术组203例。Meta分析结果显示：内镜组手术时间长于传统手术组[加权平均差（weighted mean difference，WMD）=13.56 min；95%置信区间（confidence interval，CI）=9.36~17.75 min，P<0.001]；但在术后满意度评分（WMD=2.85；95%CI=2.03~3.67，P<0.001）、切口长度（WMD=-17.60 mm；95%CI=-30.74~-4.47 mm，P<0.01）、术中出血量（WMD=-16.32 mL；95%CI=-26.67~-5.97 mL，P<0.01）方面均优于传统手术组；在肿瘤直径（WMD=-0.19 mm；95%CI=-2.91~2.54 mm，P=0.89）、术后引流量（WMD=-5.53 mL；95%CI=-14.16~3.10 mL，P=0.21）、面神经损伤发生率[比值比（odds ratio，OR）=0.82；95%CI=0.25~2.71，P=0.74]、耳大神经损伤发生率（OR=2.40；95%CI=0.36~16.18，P=0.37）、平均住院时间（WMD=-1.2 d；95%CI=-3.25~0.84 d，P=0.25）方面，2组差异无统计学意义。结论： 基于当前有限证据，内镜下手术治疗下颌下腺良性肿瘤可以显著缩短切口长度、减少术中出血量，并提高患者术后满意度，但会延长手术时间。

关键词: 下颌下腺, 内镜手术, 传统手术, Meta分析

Abstract:

Objective: To systematically evaluate the clinical efficacy of endoscopic versus conventional surgery for the treatment of benign submandibular gland tumors. Methods: Databases including China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), VIP, Wanfang, PubMed, EMBase, and the Cochrane Library were searched according to the search strategy, with the search period up to January 1, 2024. Two independent reviewers assessed the quality of the included studies using the Newcastle-Ottawa scale (NOS), and a Meta-analysis was subsequently performed. Results: A total of 9 studies were included, comprising 1 randomized controlled trial (RCT) and 8 non-randomized controlled trial (nRCT), with a total of 356 patients, 153 in the endoscopic group and 203 in the traditional group. Meta-analysis results indicated that the endoscopic group had a significantly longer operative time than the traditional group [weighted mean difference (WMD)=13.56 min; 95% confidence interval(CI)=9.36 to 17.75 min; P<0.001]. However, the endoscopic approach demonstrated superior outcomes in postoperative satisfaction (WMD=2.85; 95% CI=2.03 to 3.67; P<0.001), incision length (WMD=–17.60 mm; 95% CI=–30.74 to –4.47 mm; P<0.01), and intraoperative blood loss (WMD=–16.32 mL; 95% CI=–26.67 to –5.97 mL; P<0.01). No statistically significant differences were observed between the two groups in tumor diameter (WMD=–0.19 mm; 95% CI=-2.91 to 2.54 mm; P=0.89), postoperative drainage volume (WMD=–5.53 mL; 95% CI=–14.16 to 3.10 mL; P=0.21), the incidence of facial nerve injury [ (odds ratio, OR) = 0.82; 95% CI=0.25 to 2.71; P=0.74], the incidence of great auricular nerve injury (OR=2.40; 95% CI=0.36 to 16.18; P=0.37), or the average length of stay (WMD=–1.2 days; 95% CI=–3.25 to 0.84 days; P=0.25). Conclusion: Based on the current limited evidence, endoscopic surgery for benign submandibular gland tumors can significantly shorten incision length, reduce intraoperative blood loss, and improve postoperative patient satisfaction, but prolongs operative time.

Key words: submandibular gland, endoscopic surgery, traditional surgery, Meta-analysis

中图分类号: 

• R782