甲状腺次全切除术中甲状腺下动脉主干结扎对甲状旁腺功能影响的系统评价

A systematic review of the effects of the truncal ligation of inferior thyroid arteries on parathyroid function during bilateral subtotal thyroidectomy

目的评价甲状腺次全切除术中甲状腺下动脉主干结扎对甲状旁腺功能的影响。方法计算机检索Pubmed、EMBASE、中国生物医学文献数据库、维普中文科技期刊数据库、万方数据库、中国知网及Cochrane图书馆从1991年1月至2009年12月出版的文章。按照纳入和排除标准筛选以甲状腺次全切除术中结扎与不结扎甲状腺下动脉主干作对比的随机对照试验。由2名研究员独立提取资料，对纳入研究的方法学质量（随机方法、分配隐藏、盲法）采用分配方案隐藏分级标准和改良Jadad评分标准进行评价（总分为7分）。使用RevMan 5.2软件，采用固定或随机效应模型，对符合入选标准的文献进行Meta分析。结果共纳入3个随机对照试验，246例患者，其中试验组（甲状腺下动脉主干结扎组）123例，对照组（甲状腺下动脉分支结扎组）123例。Meta分析显示，2组患者术后第1天和第3天血清钙离子水平[标准均数差（SMD）=-0.11,95%置信区间：-0.39～0.17，SMD=-0.34,95%置信区间：-1.00～0.33]、第1天血清总钙水平（SMD=0.09,95%置信区间：-0.23～0.42）、术后血清低血钙发生率（相对危险度=1.04,95%置信区间：0.67～1.60）、术后出现低血钙临床症状的发生率[归因危险度=-0.01,95%置信区间：-0.10～0.08]、术后甲状旁腺素水平差异均无统计学意义（均P＞0.05）。结论当前研究显示，与甲状腺下动脉分支结扎相比，甲状腺下动脉主干结扎并不引起甲状旁腺功能减退和低钙血症。

ObjectiveTo assess the effects of the truncal ligation of the inferior thyroid arteries on parathyroid function after subtotal thyroidectomy. MethodsWe searched articles published in Pubmed,EMBASE,the Chinese Biomedical Database,Vip Database of Chinese Science and Technology Periodicals,Wanfang Data, China Knowledge Resource Integrated Database and Cochrane Central Register of Controlled Trials from January 1991 to December 2009. According to the inclusion and exclusion Criteria, we included three randomized controlled trials that compared bilateral ligation of the inferior thyroid arteries with unilateral ligation of the inferior thyroid arteries during bilateral subtotal thyroid resection. The quality of studies including randomization, blinding, allocation concealment was evaluated with standard criteria and upgrade Jadad scale （Total Score 7）, and date extraction was made independently by two reviewers. Data of 3 high quality randomized trials were metaanalyzed with fixed or random effect mode1 using RevMan 5.2 software. Results Three studies were included and reported with 246 subjects. 123 were in trial group and 123 were in control group. Meta analysis showed that there were no statistically differences between two groups on serum ionized calcium values on postoperative days 1[standard mean difference （SMD） =-0.11, 95% confidence interval （CI）：-0.390.17] and 3 （SMD =-0.34, 95%CI：-1.000.33）, total serum calcium values （SMD=0.09, 95%CI：-0.230.42） on postoperative days 1, the incidence of postoperative laboratory [Relative Risk （RR）=1.04, 95%CI：0.671.60] and clinical hypocalcemia [rate difference （RD）=-0.01, 95%CI：-0.100.08],parathyroid hormone（all P〉0.05）. ConclusionThe results of this metaanalysis suggest that the truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy has no effect on parathyroid function and serum calcium.