甲状腺和甲状旁腺术后引流与否疗效比较的Meta分析

Effectiveness of routine drainage versus no-drainage after thyroid and parathyroid surgery: a Meta-analysis

目的比较甲状腺和甲状旁腺术后常规引流和不予引流的临床疗效。方法计算机检索Pub Med、EMbase、The Cochrane Library等数据库,纳入甲状腺和甲状旁腺术后引流和不予引流疗效比较的随机对照试验(RCT),检索时间从建库至2016年11月30日,同时手工检索相关杂志和资料,并追索纳入文献的参考文献。由2位作者独立评价纳入研究的质量和资料提取,并交叉核对,采用Rev Man 5.3软件进行数据分析,采用GRADEpro3.6软件评价结局指标的证据质量和推荐等级。结果纳入23个RCT,共3 036例患者。Meta分析结果显示,2组在再次手术、切口血肿、血清肿、出血、无需处理的颈部轻微隆起发生率的差异无统计学意义(P>0.05);引流组较非引流组切口感染发生率高、术后当天及第1天切口疼痛评分高、住院时间长,差异具有统计学意义。结论现有证据表明单纯性甲状腺和甲状旁腺术后引流并没有降低术后并发症的发生率,反而升高了切口感染率和疼痛评分,并明显延长了住院时间。

Objective To clarify the clinical effectiveness of placing drainage and no-drainage after thyroid and parathyroid surgery. Methods The databases were retrieved orderly from the dates of their establishment to November 29 th, 2016, including Pub Med, EMbase, The Cochrane Library and so on. The literature was screened strictly according to inclusive criteria. After the study selection, assessment and data extraction were conducted by the two reviewers independently, and Meta-analyses were performed by using Rev Man5.3 software. The level of evidence was assessed by using the GRADEpro3.6 soft ware. Results A total of 23 studies involving 3 036 participants were included. There was no significant difference between the two groups in the rate of re-operation, hematoma, sermon, hemorrhage and the slight bulge in the neck that does not need to deal with. However, the wound infection rates were significantly different between the two groups [RR = 2.51, 95%CI（1.28 to 4.92）, I2= 0%, P=0.008]; as were Incision pain score for the intraday after operation [SMD = 0.70,95% CI（0.26 to 1.14）, I2= 76%, P=0.002], and the first day after operation [SMD=1.26, 95% CI（0.75 to 1.77）,I2= 93%, P〈0.000 1]; and the length of hospital stay also was significantly different [SMD=1.74, 95% CI（1.27 to 2.21）, I2= 96%, P〈0.000 01]. Conclusion The evidence showed that routine drainage after thyroid and parathyroid surgery can not significantly reduce the incidence of postoperative complications; instead, they can increase the rates of wound infection, the incision pain score and the duration of hospital stay.