摘要
目的评价腔镜下不同手术入路的甲状腺切除术的临床应用效果,为进一步规范腔镜下甲状腺切除术提供更合理、科学的治疗依据。方法计算机检索国内外文献数据库,收集其中有关腔镜下甲状腺切除术的随机对照试验(RCT)、临床对照试验(CCT)、临床试验及其他比较研究的文献进行系统分析。结果检索得到相关文献500余篇,纳入系统分析13篇,其中颈部组7篇,颈外组6篇,研究患者分别为503例和415例,平均年龄分别为42.6岁和41.4岁,男女组成分别为78/425和63/352(P>0.90)。颈部入路和颈外入路的甲状腺切除平均时间分别为(78.3±19.5)min和(69.5±27.1)min(P>0.10)。两组术中中转开放率分别为17/470和1/415(P<0.001)。术后发生低钙血症颈部组14例,颈外组0例(P<0.01),两组喉返神经损伤、术后切口感染及术后出血发生率均较低且无明显差异。根据语言反应量表评定的术后美容效果颈部组(3.84±0.294),而颈外组为(3.4±0.6)(P<0.01)。结论腔镜下甲状腺切除术颈部组比颈外组术后并发症发生率稍高,且术中中转开放手术比例较高,手术时间和术中出血量等差异无统计学意义,美容效果有待进一步评价。
Objective To evaluate clinical application of the different operative approaches of endoscopic thyroidectomy and provide a more rational and scientific treatment measures for endoscopic thyroidectomy.Methods Search all the related literatures in the domestic and foreign databases.Collect all the randomized controlled trials（RCT）,clinical controlled trials（CCT）,clinical trials and other comparative study of literatures about endoscopic thyroidectomy.Make a systemic analysis of all the literatures included.Results More than 500 literatures were searched,we selected 13 literatures for analysis.There＇re 7 literatures included in cervical group（Group A,n=503）and 6 literatures in extra-cervical group（Group B,n=415）.The mean operative times were（78.3±19.5） minutes for group A and（69.5±27.1） minutes for group B（P0.10）.The conversion to open surgery happened in 17 patients in group A and only 1 in group B（P0.001）.Postoperative hypocalcemia occurred in 14 cases in group A but no cases in group B（P0.01）.other complications such as recurrent laryngeal nerve injury,postoperative wound infection and postoperative bleeding had no significant differences between the two groups.The cosmetic results,evaluated by verbal response scales respectively as follows：group A（3.84±0.294）and geoup B（3.4±0.6）（P0.01）.Conclusion The results show that the incidence rates of hypocalcemia and conversion to open surgery are a little higher in cervical group.Operative time and operative bleeding have no significant difference between two groups.Cosmetic results need to be further evaluated.
出处
《四川医学》
CAS
2010年第6期728-731,共4页
Sichuan Medical Journal
关键词
腔镜
甲状腺切除术
手术方法
比较分析
endoscopy vedio-assisted
thyroidectomy
operative approach
systemic review
