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目的采用Meta分析方法评估胸锁乳突肌瓣预防腮腺切除术后味觉出汗综合征的效果。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、CBM、VIP、CNKI和WanFang Data中从建库至2012年3月收录的关于采用胸锁乳突肌瓣预防腮腺切除术后味觉出汗综合征的随机对照试验。由2位评价者独立对符合纳入标准的研究进行资料提取、质量评价并交叉核对后,采用RevMan 5.1软件进行Meta分析。结果最终纳入10个研究,共825例腮腺切除术患者。Meta分析结果表明:与空白对照组相比,采用胸锁乳突肌瓣可使腮腺切除术患者术后味觉出汗综合征主观发生风险显著降低78%[OR=0.22,95%CI(0.08,0.59),P=0.003],客观发生风险显著降低83%[OR=0.17,95%CI(0.05,0.60),P=0.006];敏感性分析显示上述结果稳定性好。基于GRADE系统的证据等级均为“低级”。漏斗图结果显示无明显发表偏倚。结论当前证据表明使用胸锁乳突肌瓣能显著降低腮腺切除术患者术后味觉出汗综合征的主观及客观发生率。但鉴于纳入研究的局限性,建议行更多大样本、高质量的随机对照试验,并将是否影响胸锁乳突肌功能作为结局指标之一做进一步论证。
Objective To evaluate the effect of sternocleidomastoid flap on prevention of post-parotidectomy sweating syndrome by Meta-analysis. Methods A computer-based randomized controlled search of the Cochrane Library, MEDLINE, EMbase, CBM, VIP, CNKI and WanFang Data for the prevention of post-parotidectomy sweat syndrome using a sternocleidomastoid flap Control test. Two reviewers independently performed data analysis, quality evaluation and cross-checking on eligible studies, and Meta-analysis was performed using RevMan 5.1 software. Results Finally included 10 studies, a total of 825 cases of parotidectomy patients. Meta-analysis showed that the risk of postoperative subjective taste sweating syndrome was significantly reduced by 78% with sternocleidomastoid flap (OR = 0.22, 95% CI 0.08, 0.59), P = 0.003]. The objective risk decreased significantly by 83% [OR = 0.17, 95% CI (0.05, 0.60), P = 0.006]. The level of evidence based on the GRADE system is “low level.” Funnel results showed no significant publication bias. Conclusions Current evidence suggests that the use of sternocleidomastoid flap can significantly reduce the subjective and objective incidence of postoperative taste-sweating syndrome in patients undergoing parotidectomy. Given the limitations of the included studies, however, it is advisable to conduct more large-scale, high-quality, randomized, controlled trials and to further determine whether affecting the function of sternocleidomastoid muscle as an outcome measure.