喉部分切除术对放疗复发癌治疗效果的Meta分析

发布时间：2018-03-06 16:34

本文选题：单纯放疗　切入点：复发　出处：《山西医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：背景：喉癌是耳鼻咽喉头颈外科常见的恶性肿瘤之一,在头颈部上皮来源的所有原发恶性肿瘤中排名第二位。占全身恶性肿瘤的1%-5%。放射治疗喉癌控制率比较高,但也有复发。喉癌的残留和复发是临床的难题,尽管有一些方法能用于喉癌的首次治疗,但是复发的喉癌,因为病人首次接受治疗方法的不同,限制了治疗方式的选择。随着头颈部肿瘤外科的迅速发展,喉癌的研究不断加深了对肿瘤的治疗认识,传统的全喉切除术现就已逐渐的被各种新型的喉功能保留的手术方式。与全喉切除术相比较,喉部分切除术能够在切除癌病灶的情况下,尽可能保全喉部完整性,提高病人的生活质量。但是其在放疗复发癌的治疗上的地位并不明确,运用不够广泛。目标：通过搜集相关文献,运用系统回顾和meta分析的方法,对喉部分切除术治疗放疗复发癌的疗效进行分析讨论。体现出该方法的优势,为临床治疗方法选择作参考。方法：制定合适的检索策略,检索的数据库有PunMed、springerlink、万方、中国知网。检索年份为1980年-2013年,按照纳入排除标准筛选文献,并进行质量评估。入选文献的数据录入Stata12.0中,再用R语言软件对其计算分析和绘图。结果：策略检索得到文献630篇,最终39篇入选,病人总数790人。进行质量评估,18篇文章得到6分以上,21篇文章得到4或5分。肿瘤学的结果,通过随机效应模型计算集合率得到结果为：2年以上的局部控制率为86.6%(95%CI,82.2%-90.3%)；5年总体生存率为82.1%(85%CI,77.6%-86.1%)；5年无病生存率为89.4%(84.4%-93.5%)。提及拔管率的文献集合率为95.1%(95%CI,92.6%-97.2%),患者数315人。提及喉保存率的文献集合率为83.9%(95%CI,80.7%-87%),病人数为502人。结论：现有的资料和数据显示喉部分切除术对T1T2期放疗复发癌症更为有效,有很高的控制率、无病生存率和喉保存率。现有的几种术式中,垂直喉部分切除术和环状软骨上的喉部分切除术显得更为有效。
[Abstract]:Background: laryngeal carcinoma is one of the most common malignant tumors in otolaryngopharyngeal head and neck surgery. It ranks second among all primary malignant tumors of head and neck epithelium. Although there are some methods that can be used for the first treatment of laryngeal cancer, the recurrence of laryngeal cancer is due to the difference of the first treatment method. It limits the choice of treatment. With the rapid development of head and neck tumor surgery, the study of laryngeal cancer has deepened the understanding of the treatment of tumor. Traditional total laryngectomy has been gradually preserved by various new laryngeal function surgery, compared with total laryngectomy. Partial laryngectomy can preserve the integrity of larynx and improve the quality of life in the case of resection of cancer lesions, but its role in the treatment of recurrent cancer by radiotherapy is not clear and is not widely used. Objective: to analyze and discuss the curative effect of partial laryngectomy in the treatment of recurrent cancer by means of systematic review and meta analysis. Methods: a suitable retrieval strategy was established. The databases were PunMedspringerlink, Wanfang and China.The retrieval year was from 1980 to 2013. The literature was screened according to the exclusion criteria and the quality was evaluated. The data of the selected documents were entered into Stata12.0. Then R language software is used to calculate, analyze and plot it. Results: a total of 630 articles and 39 articles were selected, and the total number of patients was 790. Quality assessment was conducted in 18 articles with a score of more than 6 and 21 articles with a score of 4 or 5. The results of oncology were obtained. The results obtained by the random effect model are as follows: the local control rate of more than 2 years is 82.2- 90.33; the overall 5-year survival rate is 82.1 and 85CI77.6-86.1; the 5-year disease-free survival rate is 89.44.4- 93.55.The collection rate of the literature with reference to extubation rate is 95.1C 95CI92.6-97.20.The number of patients mentioned is 315. The 5-year disease-free survival rate is 89.44.4- 93.55.The collection rate of the literature with reference to extubation rate is 95.1C 95CI92.6-97.2U, and the number of patients is 315. The collection rate of the literature was 83.9% and the number of patients was 502. Conclusion: the available data and data show that partial laryngectomy is more effective in the treatment of recurrent cancer after T1T2 stage radiotherapy, with a high control rate, disease-free survival rate and laryngeal preservation rate. Vertical partial laryngectomy and partial laryngectomy on annular cartilage are more effective.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R739.65

【参考文献】