喉返神经监测在甲状腺再次手术中临床价值的meta分析  

meta-analysis of the clinical value of intraoperative recurrent laryngeal nerve monitoring during thyroid reoperations

作　　者：张晓[1] 刘超[2] 马贵亮[2] 毛伟征[2] ZHANG Xiao;LIU Chao;MA Gui-liang;MAO Wei-zheng(Qingdao University affiliated Qingdao Municipal Hospital,Qingdao,Shandong,266071;General surgery of Qingdao Municipal Hospital,Qingdao,Shandong,266071)

机构地区：[1]青岛大学附属第三医院,山东青岛266071 [2]青岛市市立医院普外科,山东青岛266071

出　　处：《临床普外科电子杂志》2018年第2期26-34,共9页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的采用meta分析的方法,对比甲状腺再次手术中应用喉返神经监测与常规显露的差异,探讨术中喉返神经监测在甲状腺再次手术中的应用价值。方法通过主题词与自由词联合检索的方法检索PUBMED、Cochrane Library、中国知网(CNKI)、维普、万方数据库。用RevMan5.3和Stata14.0软件进行meta分析。结果纳入16篇文献,共计2336例甲状腺再次手术。meta分析结果显示:术中喉返神经监测组喉返神经永久性和暂时性损伤发生率、喉返神经显露时间、手术时间及术后引流量均明显低于常规显露组(OR=0.41 95%CI=[0.23～0.72]P=0.002)、(OR=0.40 95%CI=[0.29～0.56]P<0.00001)、(SMD=-17.08 95%CI=[-23.36～-10.81]P<0.00001)、(SMD=-24.03 95%CI=[-35.90～-12.16]P<0.0001)、(SMD=-9.31 95%CI=[-15.70～-2.93]P=0.004),差异有统计学意义;术中喉返神经监测组与常规显露组术中出血量差异无统计学意义(SMD=-10.49 95%CI=[-24.16～3.19]P=0.13)。采用逐一剔除法对结果进行敏感性分析,结果均未发生显著改变,提示本项meta分析结果总体稳定性较好。利用Begg秩相关法对漏斗图进行量化检测,未发现存在明显的发表偏倚。结论甲状腺再次手术中,应用喉返神经监测与常规显露喉返神经两种方式相比较,喉返神经监测具有显著降低喉返神经损伤发生率,缩短神经显露时间及手术时间,减少术后引流量的优点。Objective To compare the difference between intraoperative recurrent laryngeal nerve monitoring and conventional exposure,and investigate the clinical value of intraoperative recurrent laryngeal nerve monitoring during thyroid reoperations.Methods We searched databases as PUBMED、Cochrane library、CNKI、VIP and Wan Fang by means of coherent search of keywords and free words.The metaanalysis was performed using Rev Man 5.3 and Stata14.0 software.Results A total of 16 articles involving 2336 patients were included.The results of meta-analysis indicated that the permanent and transient injury rate of the RLN,the exposure time,the operation time,the amount of postoperative drainage in the neuromonitoring group were lower than those in the visualization group(OR=0.41 95%CI=[0.23~0.72]P=0.002)、(OR=0.40 95%CI=[0.29~0.56]P<0.00001)、(SMD=-17.08 95%CI=[-23.36^-10.81P<0.00001)、(SMD=-24.03 95%CI=[-35.90^-12.16]P<0.0001)、(SMD=-9.31 95%CI=[-15.70^-2.93]P=0.004).The amount of bleeding had no statistical difference between the two groups(SMD=-10.49 95%CI=[-24.16~3.19]P=0.13).No evidence of any individual study having excessive influence was observed.The Begg's funnel plot did not indicate evidence of publication bias.Conclusion Compared with the conventional exposure,intraoperative recurrent laryngeal nerve monitoring can significantly reduce the rate of recurrent laryngeal nerve injury and the amount of postoperative drainage,short the exposure time and operation time.

关 键 词：术中喉返神经监测 常规显露 甲状腺再次手术 临床价值 META分析 

分 类 号：R653[医药卫生—外科学]