摘要
目的:对比全甲状旁腺切除术(TPTX)与全甲状旁腺切除术+自体移植术(TPTX+AT)治疗慢性肾脏病(CKD)患者继发性甲状旁腺功能亢进(SHPT)的长期预后。方法:检索Cochrane、EMBASE、Medline、Pubmed、CNKI和万方数据库关于对比TPTX与TPTX+AT治疗CKD患者SHPT的所有随机对照试验、病例对照研究或队列研究,检索时限均从建库至2016年11月。文献质量评价工具采用纽卡斯尔—渥太华量表(NOS),Meta分析通过RevMan 5.1.0软件进行。结果:共纳入10篇文献,总样本量1283例,TPTX组539例,TPTX+AT组744例。NOS评分为5～9颗星。与TPTX+AT相比较,采用TPTX治疗SHPT有着更低的复发率(OR=0.20;95%CI:0.11～0.38;P <0.01)、持续性SHPT率(OR=0.18;95%CI:0.10～0.33;P <0.01)、再手术率(OR=0.17;95%CI:0.06～0.54;P=0.002)、手术时间(WMD=-17.30;95%CI:-30.53～-4.06;P <0.05),但甲状旁腺功能减退发生率更高(OR=2.97;95%CI:1.09～8.08;P=0.01)。而两种手术方式在术后SHPT症状改善率、并发症发生率、钙剂或维生素D使用率以及住院时间上并无差异(P>0.05)。结论:在术后复发率、再手术率和手术时间方面,TPTX对CKD患者SHPT的治疗优于TPTX+AT,但甲状旁腺功能减退率则高于TPTX+AT,长期疗效仍需更多大规模高质量的临床研究加以验证。
Objective： The present study aimed to compare total parathyroidectomy withoutautotransplantation （TPTX） versus total parathyroidectomy with autotransplantation （TPTX ＋ AT） forSecondary Hyperparathyroidism （SHPT） with respect to long-term postoperative outcomes. Meth-ods： Citations were identified in the Cochrane Library, EMBASE, Medline, Pubmed, CNKI and WanFang Database through Nov. 2016. The Newcastle-Ottawa Scale was used to assess the methodologicalquality of included studies. All data were analyzed using the Review Manager 5.3. Results：A total of 10 studies comprising 1283 patients were identified （TPTX： 539 vs. TPTX＋AT： 744）. TheNOS scores of all the included studies were 5 or above. Compared with TPTX＋AT, patients in theTPTX group had lower rates of ‘recurrence’（OR=0.20; 95% , 0.11-0.38;P〈0.01）, ‘recurrence orpersistence’（OR=0.18; 95%CI, 0.10-0.33;P〈0.01）, ‘reoperation due to recurrence or persistence’（OR=0.17; 95% , 0.06-0.54;P=0.002）, and less‘Operative time’（WMD=-17.30; 95% , -30.53 to-4.06;P〈0.05）, except a higher risk of ‘hypoparathyroidism’（OR=2.97; 95% , 1.09-8.08;P=0.01）.Besides, no significant differences were found in‘Symptomatic improvement’,‘Complications’,‘Drug requirements’, and‘Hospital stays’（P〉0.05）. Conclusion： The present finding indicatingthat TPTX is superior to TPTX＋AT referring to the above indexes, but the conclusion still need to betested in a large-scale confirmatory trial.
作者
胡茂飞
林惠
高新春
符才波
刘庆
刘智龙
杨洁
康忠晶
王春喜
裘年存
HU Mao-fei;LIN Hui;GAO Xin-chun;FU Cai-bo;LIU Qin;LIU Zhi-long;YANGJie;KANGZhong-jing;WANGChun-xi;QIU Nian-cun(Department of General Surgery,Hainan Branch of Chinese PLA General Hospital,Sanya 572000,China;Department of Hematology,First Affiliated Hospital of Hainan Medical College,Haikou 570100,China;Department of General Surgery,Changzheng Hospital Amliated to the Second Military Medical University,Shanghai 200003,China)
出处
《中国现代普通外科进展》
CAS
2018年第10期783-790,共8页
Chinese Journal of Current Advances in General Surgery
