摘要目的 探讨外科手段预防腮腺切除术后味觉出汗综合征和面部凹陷畸形的疗效.方法 检索1989年1月至2008年12月期间万方数据库、中国生物医学文献数据库、中国学术期刊全文数据库和维普数据库所收录的有关通过外科治疗手段预防味觉出汗综合征及面部凹陷畸形的中文对照研究文献26篇.采用RevMan4.2软件对纳入文献的数据进行荟萃分析(Meta分析).结果 Meta分析显示外科治疗手段在预防腮腺切除术后主观症状评价和淀粉-碘试验客观评价味觉出汗综合征及面部凹陷畸形均有帮助,它们的累计优势比(95%的可信区间)分别为:0.14(0.07～0.25),0.21(0.17～0.26)和0.09(0.04～0.19).外科治疗组和对照组之间并发症发生率差异均有统计学意义(Z值分别为6.42、13.70、6.43,P值均＜0.05).胸锁乳突肌瓣可降低主观和客观评价的味觉出汗综合征及面部凹陷畸形的发生率(Z值分别为2.33、7.48、7.78,P值均＜0.05).脱细胞真皮基质可降低主观和客观评价的味觉出汗综合征的发生率(Z值分别为6.02、5.72,P值均＜0.05),但不能降低面部凹陷畸形的发生率(P＞0.05).结论 Meta分析显示,通过外科手段可以减少腮腺切除术后味觉出汗综合征及面部凹陷畸形并发症的发生,改善患者术后的生存质量.

abstractsObjective To explore the curative effects on surgical methods for the prevention of Frey syndrome and a concave facial deformity after parotidectomy.Methods A literature search was performed using the Wanfang Database,Chinese Biomedical Literature Disk Database,Chinese Digital Hospital Library and Chinese Scientific Journals Database of VIP from January 1989 to December 2008.Twenty-six Chineselanguage controlled studies involving surgical techniques for prevention of Frey syndrome and the concave facial deformity after parotidectomy were identified.Review manager 4.2 software was applied for Meta analysis.Results Meta-analysis for surgical techniques to prevent symptomatic Frey syndrome,a positive starch-iodine test,and contour deformity,favored intervention with a cumulative odds ratio ( OR) of 0.14 [95% confidence interval (CI) ,0.07-0.25] ;OR,0.21 (95% CI,0.17-0.26) ;and OR,0.09 (95% CI,0.04-0.19) ,respectively.There was a significant difference in the incidence of these complications between surgical treatment groups and control groups ( Z = 6.42,Z = 13.70,Z = 6.43,all P ＜ 0.05 ).The application of a sternocleidomastoid muscle flap decreased the incidence of symptomatic Frey syndrome ( Z =2.33,P ＜ 0.05),positive starch-iodine test (Z = 1.48,P ＜ 0.05) and contour deformity (Z = 7.78,P ＜0.05).The application of acellular dermal matrix decreased the incidence of symptomatic Frey syndrome (Z =6.02,P ＜ 0.05 ) and positive starch-iodine test ( Z = 5.72,P ＜ 0.05 ) but did not decrease the incidence of contour deformity (Z = 1.27,P ＞ 0.05).Conclusion Meta-analysis of operative techniques to prevent symptomatic Frey syndrome,a positive starch-iodine test,and facial asymmetry suggests that such methods are likely to reduce the incidence of these complications and improve the quality of life after parotidectomy.