分化型甲状腺癌手术方式选择的Meta分析  

Choice of surgical procedure for differentiated thyroid cancer:a Meta-analysis

作　　者：李铎伟[1] 车向明[1] 刘俊松[1] 龙厚隆[1] 贺仕才[1] 陈锐[1] 

机构地区：[1]西安交通大学医学院第一附属医院普通外科,陕西西安710061

出　　处：《中国普通外科杂志》2012年第5期526-531,共6页China Journal of General Surgery

摘　　要：目的:从副损伤、生存率、复发率等三方面对甲状腺全切术(TT)和甲状腺部分切除术(PT)治疗分化型甲状腺癌进行对比评价,以期为手术方式选择提供参考和依据。方法:收集国内外多个数据库符合入选标准的13个对照临床研究,采用固定效应模型和随机效应模型对入选患者的副损伤、生存率、复发率资料进行Meta分析。结果:TT的喉返神经损伤率高于PT组(OR=1.58,95%CI=1.04～2.42,P=0.03),TT组的甲状旁腺损伤率高于PT组(OR=4.29,95%CI=3.09～5.94,P<0.000);两组中短期(20年以内)生存率无明显差异;低危患者TT组的复发率低于PT组的复发率(OR=0.42,95%CI=0.32～0.55,P<0.000)。结论:不同危险等级的分化型甲状腺癌患者应实行个体治疗原则,主张对低危患者实行较为保守的手术切除范围。Objective：To assess and compare the two procedures,total thyroidectomy（TT） and partial thyroidectomy（PT）,for differentiated thyroid cancer in terms of associated injuries,survival and recurrence rate,so as to provide a reference and basis for surgical procedure option of this disease. Methods：Thirteen controlled clinical trials that met the inclusion criterion were collected from several domestic and global databases,and a Meta-analysis was performed on the data concerning associated injuries,survival and recurrence rate of the patients selected using fixed-effects and random-effects model,respectively. Results：The incidences of recurrent laryngneal nerve injury and parathyroid injury of TT group were both significantly higher than those of PT group [（OR=1.58,95% CI=1.04–2.42,P=0.03）,（OR=4.29,95% CI=3.09–5.94,P0.000）].There was no difference in short-to mid-term survival（20 years or less） between the two groups,while the recurrence rate of the low-risk patients in TT group was significantly lower than that in PT group（OR=0.42,95% CI=0.32–0.55,P0.000）. Conclusion：For patients with differentiated thyroid cancer at different risk levels,the principle of individualized treatment should be implemented,and the relatively conservative resection is appropriate for the low-risk patients.

关 键 词：甲状腺肿瘤/外科学 甲状腺切除术 META分析 

分 类 号：R736.1[医药卫生—肿瘤]