全乳晕腔镜手术与传统开放手术治疗甲状腺癌临床效果的Meta分析  

Comparison of endoscopic thyroidectomy via complete areolar approach and conventional open surgery in treatment of thyroid cancer:a meta-analysis

作　　者：侯建忠 张颖超 樊友本[1] 伍波[1] HOU Jian-zhong;ZHANG Ying-chao;FAN You-ben(Department of General Surgery,the Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院普通外科,上海200233

出　　处：《腹腔镜外科杂志》2020年第5期321-327,共7页Journal of Laparoscopic Surgery

摘　　要：目的:采用Meta分析方法比较全乳晕腔镜手术与传统开放手术治疗甲状腺癌的临床效果。方法:计算机检索PubMed、Embase、The Cochrane Library、Web of Science等外文数据库及中国知网、万方、维普、中国生物医学文献等中文数据库,时间限定为2020年1月前。提取数据后采用RevMan 5.3软件进行Meta分析。结果:最终纳入8项研究,共1095例患者,其中全乳晕腔镜组453例,传统开放手术组642例。Meta分析结果显示,与传统开放手术相比,全乳晕腔镜组手术时间较长(MD=35.27,95%CI=17.63~52.91,P<0.0001),但术中出血量较少(MD=-9.89,95%CI=-18.19^-1.60,P=0.02)。两组中央区淋巴结清扫数量(MD=0.06,95%CI=-0.06~0.18,P=0.32)、术后引流量(MD=8.44,95%CI=-13.47~30.35,P=0.45)、术后住院时间(MD=-0.90,95%CI=-2.63~0.83,P=0.31)、术后出血(OR=0.43,95%CI=0.10~1.79,P=0.24)、术后感染(OR=0.43,95%CI=0.14~1.30,P=0.13)、术后声嘶(OR=0.60,95%CI=0.24~1.48,P=0.26)、暂时性低钙血症(OR=0.59,95%CI=0.31~1.10,P=0.10)差异均无统计学意义。结论:全乳晕入路腔镜甲状腺癌手术虽然手术时间较长,但术中出血量较少,且在淋巴结清扫数量、术后引流量、术后住院时间、术后出血、术后感染、术后声嘶、术后暂时性低钙血症、术后复发等方面能达到与传统开放手术相同的效果,安全可行,可作为甲状腺外科的重要术式选择。Objective:To compare the clinical effectiveness of endoscopic thyroidectomy via complete areolar approach and conventional open thyroidectomy in treatment of thyroid cancer with meta-analysis.Methods:Foreign databases such as PubMed,Embase,the Cochrane Library,and Web of Science,as well as Chinese databases such as CNKI,Wanfang,Weipu and China Biology Medicine disc were searched,the literatures were limited before Jan.2020.And the Review Manager software(version 5.3)was used for statistical analysis.Results:Eight studies were finally included involving 1095 patients,of whom 453 in the endoscopic complete areolar approach group and 642 in the open surgery group.Meta-analysis results showed that the endoscopic complete areolar approach group had longer operative time(MD=35.27,95%CI=17.63~52.91,P<0.0001),and less intraoperative blood loss(MD=-9.89,95%CI=-18.19^-1.60,P=0.02).But no significant differences were noted in the number of central compartment neck lymph nodes harvested(MD=0.06,95%CI=-0.06~0.18,P=0.32),postoperative drainage volume(MD=8.44,95%CI=-13.47~30.35,P=0.45),postoperative hospital stay(MD=-0.90,95%CI=-2.63~0.83,P=0.31),postoperative bleeding(OR=0.43,95%CI=0.10~1.79,P=0.24),postoperative infection(OR=0.43,95%CI=0.14~1.30,P=0.13),postoperative hoarseness(OR=0.60,95%CI=0.24~1.48,P=0.26)and postoperative transient hypocalcemia(OR=0.59,95%CI=0.31~1.10,P=0.10)between the two groups.Conclusions:The operative time of endoscopic complete areolar approach is longer,but the intraoperative blood loss is less,the number of dissected lymph nodes,postoperative drainage volume,postoperative hospital stay,postoperative bleeding,postoperative infection,postoperative hoarseness,postoperative transient hypocalcemia and postoperative recurrence can achieve the same effect as conventional open surgery.This procedure is safe and feasible and can be used as an important surgical option for thyroid surgery.

关 键 词：甲状腺肿瘤 内窥镜检查 全乳晕入路 开放手术 META分析 

分 类 号：R653[医药卫生—外科学]