经口腔前庭内镜甲状腺切除术与传统开放式甲状腺切除术治疗分化型甲状腺癌疗效比较的meta分析  

Efficacy comparison of transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy for differentiated thyroid carcinoma:a meta-analysis

作　　者：薛景毅 胡喜娥 唐海利 包国强 XUE Jingyi;HU Xi’e;TANG Haili;BAO Guoqiang(The Second Clinical Medical College of Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712000,P.R.China;Department of General Surgery,Tangdu Hospital,Air Force Medical University,Xi’an 710038,P.R.China)

机构地区：[1]陕西中医药大学第二临床医学院,陕西咸阳712000 [2]空军军医大学唐都医院普外科,西安710038

出　　处：《中国普外基础与临床杂志》2020年第12期1548-1555,共8页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的系统评价经口腔前庭内镜甲状腺切除术(transoral endoscopic thyroidectomy vestibular approach,TOETVA)与传统开放式甲状腺切除术(conventional open thyroidectomy,COT)治疗分化型甲状腺癌的可靠性和稳定性。方法计算机检索PubMed、Embase、Cochrane Library、万方和CNKI数据库中有关TOETVA与COT治疗分化型甲状腺癌效果比较的临床研究,检索日期截至2020年3月1日。遵循事先预设的纳入和排除标准,由2名研究人员严格筛选文献、提取数据后,采用RevMan 5.3软件进行meta分析。结果共有7项研究纳入本meta分析,共计1465例患者。结果表明:与COT组相比,TOETVA组的手术时间较长[WMD=35.18,P=0.0001],中央区淋巴结清扫数量较多[WMD=1.42,P=0.0005],但2组的出血量[WMD=–5.32,P=0.39]、住院时间[WMD=0.05,P=0.94]、暂时性喉返神经麻痹发生率[OR=0.81,P=0.43]、永久性喉返神经麻痹发生率[OR=1.34,P=0.73]、暂时性低钙血症发生率[OR=0.55,P=0.35]、永久性低钙血症发生率[OR=0.39,P=0.22]和出血或血肿发生率[OR=1.29,P=0.69]比较差异均无统计学意义。结论TOETVA有较高的稳定性,虽然COT的手术时间较短,但前者对颈部中央区淋巴结清扫更彻底,术后颈部无瘢痕,且术后相关并发症发生率与COT相比并无显著差异。Objective To systematically evaluate the reliability and stability of transoral endoscopic thyroidectomy vestibular approach(TOETVA)and conventional open thyroidectomy(COT)in the treatment of differentiated thyroid cancer.Methods The clinical studies of TOETVA and COT in the treatment of differentiated thyroid cancer were retrieved from major databases including PubMed,Embase,Cochrane Library,Wanfang,and CNKI by computer.The search date ended on March 1,2020.Two investigators screened the literatures strictly and extracted the data following the pre-defined inclusion and exclusion criteria,and then used RevMan 5.3 software for meta-analysis.Results A total of 7 studies including 1465 patients were included in this meta-analysis.The results showed:compared with the COT group,the operation time of the TOETVA group was longer[WMD=35.18,P=0.0001],and the number of lymph node dissections in the central area was larger[WMD=1.42,P=0.0005].But the intraoperative blood loss[WMD=-5.32,P=0.39],the length of hospital stay after operation[WMD=0.05,P=0.94],the incidences of transient recurrent laryngeal nerve palsy[OR=0.81,P=0.43],transient hypocalcemia[OR=0.55,P=0.35],permanent hypocalcemia[OR=0.39,P=0.22],permanent recurrent laryngeal nerve palsy[OR=1.34,P=0.73],and hematoma[OR=1.29,P=0.69]were not statistically significant between the two groups.Conclusions TOETVA has a higher stability.Although the COT has a shorter operation time,the former has a higher central lymph node dissection rate,and there is no scar on the neck after surgery and no significant difference in the incidence of postoperative complications.

关 键 词：分化型甲状腺癌 经口腔前庭内镜甲状腺切除术 传统开放式甲状腺切除术 META分析 

分 类 号：R736.1[医药卫生—肿瘤]