手术联合多种干预措施治疗耳部瘢痕疙瘩疗效的网状meta分析  

Network meta analysis of the effectiveness of surgery combined with multiple interventions in treating patients with ear keloids

作　　者：李晓庆[1] 刘文军[1] 段建兴 王欣[1] 王迪 张高飞 魏亚婷[1] Li Xiaoqing;Liu Wenjun;Duan Jianxing;Wang Xin;Wang Di;Zhang Gaofei;Wei Yating(Department of Burns,Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院烧伤科,650101

出　　处：《中华整形外科杂志》2018年第12期1010-1019,共10页Chinese Journal of Plastic Surgery

基　　金：国家卫生计生委公益性行业科研专项(20150228);国家自然科学基金(81660319).

摘　　要：目的采用网状meta分析方法,以手术治疗耳部瘢痕疙瘩为共同参照,比较手术联合多种干预措施治疗耳部瘢痕疙瘩的有效性。方法以"(((((((((((Ear, External[MeSH Terms])) OR (Ears, Exernal)) OR (Outer Ear)) OR (Ear, Outer)) OR (Ears, Outer)) OR (External Ear))) AND (((keloid[Mesh Terms])) OR (keloids))) AND ((((((surgery[MeSH Terms])) OR (operative therapy)) OR (operative procedures)) OR (invasive procedures)) OR (operations)))) AND (randomized controlled trial [pt])"为检索词,检索"PubMed" 、"Cochrane Library"数据库,以(('external ear’/exp) OR('auricle’/exp) OR ('ear lobe’/exp)) AND (('surgery’/exp) OR ('ear surgery’/exp)) AND ('keloid’/exp) AND ('randomized controlled trial’/exp)检索"Embase"数据库,以"耳瘢痕疙瘩,手术"为检索词检索"中国期刊全文数据库" 、"中国生物医学文献数据库" 、"维普数据库" 、"万方数据库" ,检索自数据库建库以来至2018年6月公开发表的有关手术联合多种干预措施治疗耳部瘢痕疙瘩的随机对照试验。结局指标为治疗的有效性。采用EndNote X7、Revman5.3、STATA14.0、GeMTC14.3统计软件进行文献筛选数据提取、文献质量评估、绘制网络图、发表偏倚分析、传统meta分析及异质性检验、一致性检验、相似性检验、网状meta分析。结果共纳入18篇文献,涉及8项治疗措施,共纳入1 425例耳部瘢痕疙瘩患者,纳入的18篇文献的偏倚风险均偏高。网络图显示8项治疗措施可形成28个不同的两两比较,其中纳入的18篇文献存在10个直接比较,剩余18个比较无直接证据,其比较将由网状meta分析间接比较产生。绘制漏斗图中各点基本对称,Beggs检验及Eggers检验P值均大于0.05,说明存在发表偏倚的可能性较小。传统meta分析显示手术+激素、手术+压力、手术+放疗和手术+激素+放疗的有效率均高于单纯手术,且差异具有统计学意义(P<0.05);手术+激素+放疗的有效率优于手术+激素,差异�Objective To evaluate the effectiveness of surgery combined with multiple interventions in treating patients with ear keloid by network meta-analysis.Methods Databases including " PubMed" , " Cochrane Library" were searched using key words " (((((((((((Ear, External[MeSH Terms]]] OR (Ears, Exernal]] OR (Outer Ear]] OR (Ear, Outer]] OR (Ears, Outer]] OR (External Ear]]] AND (((keloid[Mesh Terms]]] OR (keloids]]] AND ((((((surgery[MeSH Terms]]] OR (operative therapy]] OR (operative procedures]] OR (invasive procedures]] OR (operations]]]] AND (randomized controlled trial[pt]]" , database " Embase" was searched using key words ((′external ear′/exp] OR(′auricle′/exp] OR (′ear lobe′/exp]] AND ((′surgery′/exp] OR (′ear surgery′/exp]] AND (′keloid′/exp] AND (′randomized controlled trial′/exp] and Chineses journals full-text database, China biology medicine disc, VIP database, and Wanfang database were searched using key words in chinese version "耳瘢痕疙瘩,手术" to obtain the randomized controlled trails about surgery combined with multiple interventions in the treatment of ear keloid from the establishment of each database to June 2018. EndNote X7, Revman 5.3, STATA 14.0, GeMTC 14.3 statistical software were used to extract data from studies, study quality assessment, drawing network figure, publication bias analysis, traditional meta-analysis, heterogeneity test, consistency test, similarity test, network meta-analysis.Results A total of 18 trails involving 8 therapeutic measures were included, and 1 425 patients with ear keloid were included. All of the 18 trails had high risk of bias. The network figure shows that there are 28 different pairwise comparisons among the eight treatments. Of the 18 studies included, 10 were directly compared, and the remaining 18 were not directly evidenced, those comparisons will be made indirectly by the network meta-analysis. The basic symmetry of each point in the funnel plot and the P values of Beggs test and Eggers test were all greater than 0.05

关 键 词：耳 瘢痕疙瘩 外科 META分析 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]