摘要
目的系统评价小切口腔镜辅助下甲状腺切除术(minimally invasive video-assisted thyroidectomy,MIVAT)与传统开放式甲状腺切除术(conventional open thyroidectomy,COT)治疗淋巴结转移阴性甲状腺癌的有效性和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(截至2015年第3期)、CBM、CNKI、VIP及万方数据库,查找有关MIVAT与COT治疗淋巴结转移阴性甲状腺癌的随机或非随机同期对照试验,检索时间截止到2015年10月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入13个研究,共计3 083例患者。Meta分析结果显示:与COT组相比,MIVAT组的手术时间较长(MD=31.36,95%CI:27.68~35.03,P<0.05),住院时间(MD=-0.16,95%CI:-0.28^-0.04,P=0.01)和瘢痕长度(MD=-1.51,95%CI:-1.63^-1.39,P<0.05)均较短,但2组的短暂性低钙血症发生率(OR=1.29,95%CI:0.93~1.78,P=0.13)、短暂性喉返神经麻痹发生率(OR=1.42,95%CI:0.93~2.17,P=0.11)、血肿形成发生率(OR=1.21,95%CI:0.64~2.29,P=0.56)、复发率(OR=0.61,95%CI:0.28~1.33,P=0.22)、检出中央区淋巴结个数(MD=-0.10,95%CI:-0.98~0.78,P=0.82)及病检肿瘤直径(MD=-0.02,95%CI:-0.06~0.02,P=0.39)比较差异均无统计学意义。结论在严格掌握MIVAT治疗淋巴结转移阴性甲状腺癌适应证的前提下,采用MIVAT是安全可行的。
Objective To systematically evaluate the effectiveness and safety of minimally invasive video-assisted thyroidectomy（MIVAT） and conventional open thyroidectomy（COT） in treatment of thyroid carcinoma without lymph node metastasis. Methods Databases including Pub Med, EMbase, The Cochrane Library（Issue 3, 2015）, Wan Fang, CBM, VIP and CNKI were searched to collect the randomized controlled trails（RCTs） and non-RCTs about MIVAT and COT in treatment of thyroid carcinoma without lymph node metastasis. The retrieval time was from inception to October 2015. The studies were screened according to the inclusion and exclusion criterias, and the data was extracted and the quality of studies was evaluated by 2 reviewers independently. Then the Meta-analysis was conducted by using Rev Man 5.2 software. Results A total of 13 non-RCTs involving 3 083 cases were included. The results of Meta-analysis showed that： compared with COT group, operative time of MIVAT group was longer（MD=31.36, 95% CI： 27.68-35.03, P〈0.05）, hospital stay（MD=-0.16, 95% CI：-0.28--0.04, P=0.01） and length of scar（MD=-1.51, 95% CI：-1.63--1.39, P〈0.05） of MIVAT group were shorter, but there was no significant difference in the incidences of transient hypocalcemia（OR=1.29, 95% CI： 0.93-1.78, P=0.13）, transient laryngeal nerve palsy（OR=1.42, 95% CI： 0.93-2.17, P=0.11）, hemotoma（OR=1.21, 95% CI： 0.64-2.29, P=0.56）, recurrence（OR=0.61, 95% CI： 0.28-1.33, P=0.22）, number of retrieved central lymph nodes（MD=-0.10, 95% CI：-0.98-0.78, P=0.82）, and the size of tumors（MD=-0.02, 95% CI：-0.06-0.02, P=0.39） between the2 groups. Conclusion MIVAT is safe and feasible in treatment of thyroid carcinoma without lymph node metastasis when its indications are strictly controlled.
出处
《中国普外基础与临床杂志》
CAS
2016年第6期667-675,共9页
Chinese Journal of Bases and Clinics In General Surgery
