耳廓周围切口与改良Blair切口在腮腺切除术中的应用：随机对照试验的系统回顾和荟萃分析。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery Pub Date : 2025-10-01 DOI:10.1016/j.jormas.2025.102434

Tian Ci Du, Kai Lin Dong, Xin Tang Liu, Wen Jian Mao, Jian She Liu, Ye Jun Liu

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引用次数: 0

摘要

目的：比较耳周切口（PI）与改良Blair切口（MBI）在浅表良性腮腺切除术中的安全性、功能和美容效果。方法：我们对比较腮腺切除术与PI和MBI的随机对照试验（rct）进行了系统回顾和荟萃分析。截至2025年4月20日检索PubMed、Embase、Web of Science、Cochrane Library、CBM、CNKI、万方、VIP等数据库（PROSPERO: CRD42024620827）。结果包括一过性面瘫、弗雷氏综合征、耳垂麻木、面部畸形、患者满意度、唾液瘘、手术时间、术中出血量、术后引流、住院时间和切口长度。偏倚风险采用rob2评估，证据确定性采用GRADE分级。结果：11项随机对照试验包括804例患者(PI 401；MBI 403)符合纳入标准。合并分析显示，PI可显著减少短暂性面瘫(RR = 0.60,95% CI: 0.39-0.93；中度确定性)，弗雷氏综合征(RR = 0.27,95% CI: 0.13-0.55；高确定性)、耳垂麻木(RR = 0.53,95% CI: 0.34-0.84；中度确定性)和面部畸形(RR = 0.19,95% CI: 0.08-0.46；高确定性)，以及更高的患者满意度(RR = 1.24,95% CI: 1.16-1.33；温和的确定性)。两组唾液瘘发生率差异无统计学意义(RR=0.70；95% ci, 0.31-1.59；低确定性)和手术时间(SMD=-0.29；95% ci, -1.30-0.71；非常低的确定性)。术中出血、术后引流、住院时间和切口长度有利于PI，但由于异质性高，证据质量降至低/极低（I² = 72-97%）。结论：相对于MBI， PI是一种安全、美观的腮腺浅表良性肿瘤治疗方法。进一步的多中心、高质量的随机对照试验需要长期随访来证实这些发现。

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Periauricular incision vs. Modified blair incision in parotidectomy: A systematic review and meta-analysis of randomized controlled trials

Purpose

To compare safety, functional outcomes, and cosmetic results of periauricular incision (PI) versus modified Blair incision (MBI) in superficial benign parotidectomy.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing parotidectomy with PI versus MBI. PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang, and VIP databases were searched through April 20, 2025 (PROSPERO: CRD42024620827). Outcomes included transient facial palsy, Frey’s syndrome, earlobe numbness, facial deformity, patient satisfaction, salivary fistula, operative time, intraoperative blood loss, postoperative drainage, hospital stay, and incision length. The risk of bias was assessed with RoB 2 and evidence certainty was graded by GRADE.

Results

Eleven RCTs encompassing 804 patients (PI 401; MBI 403) met the inclusion criteria. Pooled analysis demonstrated that PI significantly reduced transient facial palsy (RR = 0.60, 95 % CI: 0.39–0.93; moderate certainty), Frey’s syndrome (RR = 0.27, 95 % CI: 0.13–0.55; high certainty), earlobe numbness (RR = 0.53, 95 % CI: 0.34–0.84; moderate certainty), and facial deformity (RR = 0.19, 95 % CI: 0.08–0.46; high certainty), as well as higher patient satisfaction (RR = 1.24, 95 % CI: 1.16–1.33; moderate certainty). No significant difference was observed in salivary fistula incidence (RR=0.70; 95 % CI, 0.31–1.59; low certainty) and operative time (SMD=-0.29; 95 % CI, –1.30–0.71; very low certainty). Intraoperative bleeding, postoperative drainage, hospitalization length, and incision length favored PI, but evidence quality was downgraded to low/very low due to high heterogeneity (I² = 72–97 %).

Conclusion

PI appears to be a safe, cosmetically superior alternative to MBI for small-to-medium benign, superficial parotid tumors. Further multicenter, high-quality RCTs with long-term follow-up are warranted to confirm these findings.

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来源期刊

Journal of Stomatology Oral and Maxillofacial Surgery Surgery, Dentistry, Oral Surgery and Medicine, Otorhinolaryngology and Facial Plastic Surgery

CiteScore

2.30

自引率

9.10%

发文量

审稿时长

23 days