甲状腺乳头状癌行预防性颈中央区淋巴清扫术局部复发及并发症的Meta分析

The effect of prophylactic central compartment neck dissectionon local recurrenceand complications in Patients with Papillary Thyroid Cancer:A Meta-analysis

目的评价预防性颈中央区淋巴结清扫术(PCND)治疗甲状腺乳头状癌的疗效及安全性。方法计算机检索2001年1月~2015年1月Pubmed、ISI-Web of science、Medline、The Cochrane Library、CNKI中国期刊全文数据库、维普中文科技期刊数据库、万方数据资源系统等电子数据库公开发表的有关对比甲状腺切除术加PCND与单纯甲状腺切除术治疗甲状腺乳头状癌的文献,按纳入及排除标准筛选文献,评价文献质量后提取相关数据,采用Rev Man5.1软件进行Meta分析,计算合并比值比(OR)。结果 18个研究共3985例符合入选条件,其中1940例甲状腺切除术加PCND,2045例单行单纯甲状腺切除术。甲状腺切除术+PCND组的局部复发率明显低于单纯甲状腺切除术组,差异有统计学意义(OR=0.52,95%CI:0.40~0.69,P<0.00001);术后暂时性低钙血症的发生率明显高于单纯甲状腺切除术组,差异有统计学意义(OR=2.64,95%CI:2.15~3.25,P<0.00001)。结论 PCND可降低甲状腺乳头状癌局部复发率,术后低钙血症的发生是暂时性的。因此,对于高危的甲状腺乳头状癌行甲状腺切除术加PCND是更有利的。

Objective To evaluate the efficacy and safety of prophylactic central neck dissection（PCND）for papillary thyroid cancer（PTC）.Methonds The publicly available literature published from January 2001 to January 2015 concerning about thyroidectomy plus PCND versus thyroidectomy alone for PTC was retrieved by computer searching the ISI-Web of science,Pubmed,Medline,The Cochrane Library,CNKI,VIP,Wanfang Data resource system and other electronic databases.Eligible studies fulfilled the following inclusion and exclusion criteria,then evaluated the quality of the eligible studies.Meta-analysis was performed by using RevMan 5.1 software and odds ratio（OR）was calculated.Result Eighteen studies were finally included with a total of 3985 patients,of whom 1940 cases underwent thyroidectomy plus PCND and 2045 cases received total thyroidectomy alone.As shown by the Meta-analysis results,there were significant improvements were seen in thyroidectomy plus PCND compared with thyroidectomy alone group in respects to the local recurrence rate（OR=0.52,95% CI：0.40-0.69,P〈0.00001）,but a higher recurrence rate of temporary hypocalcemia（OR=2.64,95% CI：2.15-3.25,P〈0.00001）.Conclusion For patients with clinically node negative（cN0）PTC,PCND reduce the postoperative local recurrence rate,and postop-erative hypocalcemia was transient.PCND should be performed for the high risk PTC patient.