暴露与非暴露喉返神经的甲状腺手术对术后喉返神经损伤影响的Meta分析

Influence of thyroid surgery with and without exposure of recurrent laryngeal nerve on postoperative recurrent laryngeal nerve injury: a Meta-analysis

目的：比较甲状腺手术中暴露喉返神经与非暴露喉返神经对术后喉返神经损伤的影响。方法：检索国内外数据库中有关暴露与非暴露喉返神经甲状腺手术的随机对照试验（RCT）。按纳入和排除标准筛选文献、提取资料和质量评价后，对两种手术方式的喉返神经暂时性和永久性损伤发生率行Meta分析。结果：共纳入7个RCT，共2 074例患者，其中1 015例甲状腺手术中暴露喉返神经（暴露组），1 059例未暴露喉返神经（非暴露组）。Meta分析结果显示，无论是喉返神经暂时性损伤发生率还是喉返神经永久性损伤发生率，暴露组均低于非暴露组（OR=0.19，95% CI=0.11~0.34；OR=0.14，95% CI=0.06~0.34），差异均有统计学意义（均P〈0.05）。结论：甲状腺手术中常规暴露喉返神经可有效降低术后喉返神经损伤发生率。由于文中未做其他临床指标的比较，故两种手术方式的利弊尚需更多大样本、高质量的RCT进一步验证。

Objective： To compare the influence of exposure and non-exposure of recurrent laryngeal nerve （RLN） during thyroid surgery on the incidence of postoperative RLN injury.Methods： The randomized controlled trials （RCTs） comparing RLN exposure and RLN non-exposure during thyroid surgery were searched from several national and international databases. After screen for inclusion, data extraction, and quality assessment, the incidence of temporary and permanent postoperative RLN injury of the two procedures were compared by Meta-analysis.Results： Seven RCTs were finally included, with a total of 2 074 patients, of whom, 1 015 cases underwent thyroid surgery with RLN exposure （exposure group） and 1 059 cases without RLN exposure （non-exposure group）. Meta-analysis results showed that either the incidence of temporary or permanent postoperative RLN injury in exposure group was lower than that in non-exposure group （OR=0.19, 95% CI=0.11–0.34; OR=0.14, 95% CI=0.06–0.34）, and the differences had statistical significance （both P〈0.05）.Conclusion： Routine RLN exposure in thyroid surgery can effectively reduce the incidence of postoperative RLN damage. However, because no other clinical variables were compared in this study, the pros and cons of the two procedures need further verification with a large sample and high-quality RCTs.