甲状腺、甲状旁腺术后常规引流的系统评价  

Wound Routine Drainage after Thyroid and Parathyroid Surgery:A Systematic Review

作　　者：王尚前[1] 邵国安[1] 胡学军[1] 张虎 刘贵峰[1] 

机构地区：[1]新疆医科大学第五附属医院肿瘤诊疗中心,乌鲁木齐830011

出　　处：《中国循证医学杂志》2012年第7期830-839,共10页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价甲状腺、甲状旁腺手术后放置引流管的临床效果。方法计算机检索e CochraneCentral Register of Controlled Trials(CENTRAL)、MEDLINE、EMbase、SCI、CNKI,纳入甲状腺、甲状旁腺术后常规放置引流管与不放置引流管比较的随机对照试验(RCT)。检索时间均从建库至2011年3月29日,同时手检相关专业杂志和资料,并追索纳入文献的参考文献。由两位评价员独立评价纳入研究的质量、进行资料提取和交叉核对后,采用RevMan 5.1.2软件进行Meta分析。结果纳入16个RCT,共1 907例患者。Meta分析结果显示,在再次手术、切口血肿/血清肿、切口感染、皮下积液发生率方面,甲状腺、甲状旁腺术后常规放置引流管与不放置引流管相比,两组差异均无统计学意义(P>0.05)。引流组的术后切口疼痛评分优于未引流组,两组差异有统计学意义[RR=2.15,95%CI(1.10,4.23),P=0.03];但住院时间比未放置组长,两组差异有统计学意义[SMD=0.79,95%CI(0.38,1.20),I2=93%,P=0.000 2]。结论现有证据表明甲状腺、甲状旁腺术后常规放置引流并不能显著降低术后并发症的发生率,反而会增加住院时间。但鉴于目前的证据是基于无胸骨后甲状腺肿手术、正常的凝血指数和没有颈部淋巴结清扫术基础上而得出的,因此本系统评价结果并不适用于上述情况;又因为本研究纳入的所有RCT质量均较低,且缺乏多中心、大样本的RCT,因此应开展更多高质量大样本的RCT研究对此问题进行深入研究。Objective To learn the postoperative wound complications of thyroid and parathyroid, respiratory complications, duration of hospital stay and postoperative mortality, so as to further clarify the clinical effectiveness of placing drainage tube after thyroid and parathyroid surgery. Methods The following databases as The Cochrane Library, MEDLINE, EMbase, SCI and CNKI were retrieved orderly from the date of their establishment to March 29th, 2011. The literature was screened strictly according to inclusive criteria, included studies were analyzed using RevMan5.1.2 software, and the evidence levels of all indicators were evaluated using GRADEpro 3.5.1 software. Results A total of 16 studies involving 1 907 participants were included. There was no high-quality literature. No case reports of death and respiratory distress syndrome. Comparing the drainage group with the non-drainage group among the 16 studies, no significant dif- ference was found in the incidence of re-operation, wound hematoma/seroma, wound infection and subcutaneous fluids. Incision pain score was significantly different between the two groups （RR=2.15, 95%CI 1.10 to -4.23, P=0.03）; and the duration of hospital stay was significantly prolonged in the drainage group （SMD=0.79, 95%CI 0.38 to -1.20, F=93%, P=0.000 2）. Conclusion The evidence shows that drainage after thyroid and parathyroid surgery can not significantly reduce the incidence of postoperative complications; but increase the duration of hospital stay. Current evidence is based on the circumstance of non-substernal goiter surgery, normal coagulation indexes and non neck lymphadenectomy, which does not apply to the conclusion of this study. It is suggested that this issue should be further studied in the future due to the lack of high-quality, multi-center and large-scale RCTs.

关 键 词：甲状腺 甲状旁腺 引流 系统评价 META分析 随机对照试验 

分 类 号：R653[医药卫生—外科学]