甲状腺手术中显露喉返神经的安全性Meta分析

Safety of exposure of recurrent laryngeal nerve in thyriod surgery:a Meta-analysis

目的 系统评价甲状腺手术中显露喉返神经的安全性。方法 根据预定纳入、排除标准，在中国知网（CNKI）、万方数据库（Wanfang Data）、维普数据库（VIP）和中国生物医学文献数据库（CBM）等中文数据库中对甲状腺手术中显露喉返神经的文献进行检索。检索时限均从建库至2013 年12 月。采用Rewman ．1 软件对资料进行Meta 分析。结果 共纳入符合标准的文献20 篇（均为中文），共计25 435 例患者，其中试验组10 592 例，对照组14 843 例，试验组为甲状腺手术术中显露喉返神经，对照组为甲状腺手术术中不显露喉返神经。Meta 分析结果显示：试验组喉返神经损伤的总发生率显著低于对照组（RR =0．40，95％CI ．28 ～．58， P ＜0．05）；试验组暂时性喉返神经损伤的发生率与对照组无统计学差别（RR =0．75，95％CI ．52 ～．10， P ＞0．05）；试验组永久性喉返神经损伤的发生率显著低于对照组（RR =0．19，95％CI ．11 ～．32， P ＜0．001），试验组甲状旁腺损伤的发生率与对照组无统计学差异（RR =0．01，95％CI ．65 ～．57，P ＞0．05）。结论 与非显露喉返神经的甲状腺手术相比，显露喉返神经的甲状腺手术能有效地减少术中喉返神经的损伤，值得临床继续应用和推广。

Objective To evaluate the safety of expose the recurrent laryngeal nerve in thyroid operation.Methods Based on inclusion , exclusion criteria , searched thyroid operation of exposure of recurrent nerve laryngeal Chinese literature in China Knowledge Resource Integrated Database （CNKI）, Wanfang （Wanfang Data） database, VIP database （VIP） and Chi-nese biomedical literature database （CBM.Time limitation was from established to 2013 Decembe.Meta-analysis of data were performed using Revman .1 softwar.Results According to the criteria, 20 papers （all Chinese） were included, a to-tal of 25 435 patients were enrolled , including 10 592 cases in test group , 14 843 cases in the control group , the test group re-ceived thyroid surgery with exposure of the recurrent laryngeal nerve , and the control group received the thyroid surgery without exposure of the recurrent laryngeal nerve.The results of Meta-analysis showed that the experimental group ’ s incidence rate of laryngeal recurrent nerve injury in thyroid surgery was significantly lower than that of control group （RR=0.40, 95%CI .28-.58, P 〈0.05）; experimental group temporary recurrent laryngeal nerve injury rate had no statistical differences from control group （RR=0.75, 95%CI .52-.10, P〉0.05）;the test group permanent recurrent laryngeal nerve injury inci-dence was significantly lower than the control group （RR=0.19, 95%CI .11-.32, P 〈0.001）, parathyroid injury inci-dence of test group and control group showed no significant difference （RR=0.01, 95%CI .65-.57, P〉0.05.Con-clusion Compared with non-exposure of recurrent laryngeal nerve in thyroid surgery , exposure of recurrent laryngeal nerve in thyroid surgery can reduce the recurrent laryngeal nerve injury during operation effectively , it is worthy of clinical promotion and application.