目的:通过搜索文献对喉返神经再支配手术治疗单侧声带麻痹(UVCP)进行meta分析,系统性评价喉返神经再支配手术改善UVCP嗓音功能的疗效.方法:通过检索中国知网、万方数据库及Pubmed、Web of Science,EMBASE,Cochrane Library等电子数据库,筛选文献时严格按照纳入及排除标准后进行质量评价;使用Revman 5.3软件,采用随机效应模型或固定效应模型分析异质性大小,从文献中提取主观听感知评估(GRBAS)、嗓音障碍指数(VHI)、最长发声时间(MPT)及客观声学参数基频微扰(Jitter)、振幅微扰(Shimmer)、噪声谐波比(NHR)等进行治疗前后的对比分析,评价疗效.结果:8篇文献被纳入研究,所有研究都显示患者术后GRBAS各指标的评分、VHI、声学参数Jitter、Shimmer及NHR较术前均下降,术后MPT较术前明显延长,差异均有统计学意义.结论:喉返神经再支配手术可使喉内肌获得神经再支配,能有效改善嗓音功能,具有较好的远期疗效,虽然不同吻合方式疗效无差异,但因喉返神经端端吻合存在神经错向再生导致声带矛盾运动的问题,颈袢神经因其优越的解剖条件和发音相放电的电生理学特性成为更理想的选择.进一步随访期更长、样本量更大的前瞻性随机对照研究将会增加效力的可信度.
A meta-analysis on the improvement of vocal function in unilateral vocal cord paralysis by reinnervation of the recurrent laryngeal nerve
Objective:To conduct a systematic description and meta-analysis of the treatment of unilateral vo-cal cord paralysis(UVCP)with recurrent laryngeal nerve reinnervation through literature search,and to analyze the therapeutic effect of recurrent laryngeal nerve reinnervation on improving vocal function in UVCP.Methods:Electronic databases Pubmed,Web of Science,EMBASE,Cochrane Library,CNKI,and Wanfang databases were searched using relevant keywords and screened in strict accordance with the inclusion and exclusion criteria,and quality evaluations were conducted.Reported treatment outcomes were measured by relevant data extracted from literature,such as auditory perception assessment(GRBAS),voice handicap index(VHI),maximal phonation time(MPT),jitter,shimmer,and noise harmonic ratio(NHR),etc.Meta-analysis was performed by Revman5.3 and heterogeneity was analyzed using fixed effects or random effects models.Results:Eight articles were included in this study,all of which showed that the postoperative maximum phonation time of patients was significantly prolonged compared to preoperative,while the postoperative GRBAS score,Jitter,Shimmer,and NHR decreased compared to preoperative with statistical significance.Conclusion:The innervation of the internal laryngeal muscle was obtained through the reinnervation of the recurrent laryngeal nerve,which effectively improved the patient's vocal function and had a good long-term therapeutic effect.Although there was no difference in the efficacy of sur-gical methods for reconstructing the recurrent laryngeal nerve,the anastomosis between ansa cervicalis nerve and the recurrent laryngeal nerve is more ideal.Further randomized controlled studies with longer follow-up periods and larger samples will increase the credibility of their effectiveness.
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