内镜下甲状腺切除术与常规甲状腺切除术比较的系统评价

Endoscopic thyroidectomy versus conventional thyroidectomy:a systematic review

目的评估内镜下甲状腺切除术与常规甲状腺切除术相比的有效性及安全性。方法检索国内外数据库中比较内镜下甲状腺切除术与常规甲状腺切除术的随机对照试验。完成数据提取和文献质量评价后,采用RevMan5.1软件对数据进行Meta分析。结果本评价纳入11个研究共1398例患者。内镜下甲状腺切除术的优点有美容评分高[SMD=4.23,95%CI(2.66,5.80),P<0.05]、伤口满意度高[RR=2.25,95%CI(1.89,2.70),P<0.05]。缺点是手术时间长[SMD=1.02,95%CI(0.44,1.59),P<0.05]、术后引流量多[SMD=0.89,95%CI(0.56,1.23),P<0.05]。两种手术方式的并发症、复发率均无差别。结论内镜下甲状腺切除术适用于对美容要求高的患者,同时需考虑其优缺点及费用。

OBJECTIVE To assess the efficacy and safety of endoscopic thyroidectomy versus conventional open thyroidectomy for treatment of thyroid nodules. METHODS We studied domestic and foreign information databases for randomized controlled trials about endoscopic thyroidectomy（ET）or conventional thyroidectomy（CT）for the treatment of thyroid nodules. As soon as we extracting data and accessing the quality of the included studies, we performed meta-analyses by using the RevMan 5.1 software. RESULTS A total number of 1398 patients from 11 independent studies were included in this study. ET was proven superior to CT regarding higher cosmetic score [SMD=4.23, 95%CI（2.66, 5.80）, P〈0.05]and more postoperative wound satisfaction [RR=2.25, 95%CI（1.89, 2.70）, P〈0.05]. ET showed more operating time [SMD=1.02, 95%CI（0.44,1.59）, P〈0.05] and more postoperative drainage flow [SMD=0.89, 95%CI （0.56, 1.23）, P〈0.05] when compared with CT. Besides, the complications and recurrence rate are comparable between the two methods. CONCLUSION ET can be applied to patients after strict selection, who require a higher cosmetic outcome, while considering the pros and cons of the surgery as well as the costs.