甲状腺全切除术与甲状腺次全切除术治疗多发结节性甲状腺肿的Meta分析

Meta-analysis of total thyroidectomy and subtotal thyroidectomy for multiple nodular goiter

目的评价甲状腺全切除术(TT)和甲状腺次全切除术(ST)治疗多发结节性甲状腺肿的治疗效果。方法计算机检索PubMed、Embase、Cochrane library、OVID、CNKI、万方和维普数据库,筛选出有效数据后采用Review Manager5.3软件进行比较分析。结果共纳入9篇文献,共有2397例患者,其中1323例行甲状腺全切除术(TT组),1074例行甲状腺次全切除术(ST组)。Meta分析结果表明,与ST组相比,TT组结节复发率显著降低(OR=0.07,95%CI:0.03~0.18,P<0.05),短暂性甲状旁腺功能减低发生率增高(OR=1.92,95%CI:1.41~2.62,P<0.05);2组短暂性喉返神经麻痹(OR=1.59,95%CI:0.95~2.65,P>0.05)、永久性喉返神经麻痹(OR=0.81,95%CI:0.24~2.74,P>0.05)和永久性甲状旁腺功能减低发生率(OR=1.32,95%CI:0.46~3.79,P>0.05)差异无统计学意义。结论TT较ST能降低患者结节复发率,增高短暂性甲状旁腺功能减低发生率,在治疗多发结节性甲状腺肿有一定优势。

Objective To evaluate the therapeutic effects of total thyroidectomy (TT) and subtotal thyroidectomy (ST) in the treatment of multiple nodular goiter. Methods The PubMed, Embase, Cochrane library, OVID, CNKI, Wanfang and VIP databases were retrieved by computer. The valid data was selected and compared using Review Manager 5.3 software. Results A total of 9 articles were included, with a total of 2 397 patients, of which 1 323 underwent total thyroidectomy (TT group) and 1 074 underwent subtotal thyroidectomy (ST group). Meta-analysis showed that compared with ST group, the recurrence rate of nodules was significantly lower in TT group (OR=0.07, 95%CI 0.03-0.18, P<0.05), and the incidence of transient hypoparathyroidism increased (OR=1.92, 95%CI 1.41-2.62, P<0.05). There were no significant differences in transient recurrent laryngeal nerve palsy (OR=1.59,95%CI 0.95-2.65,P>0.05), permanent recurrent laryngeal nerve palsy (OR=0.81,95%CI 0.24-2.74,P>0.05) and the incidence of permanent hypoparathyroidism (OR=1.32,95%CI 0.46-3.79, P>0.05) between the two groups. Conclusion Compared with ST, TT can reduce the recurrence rate of patients with nodules and increase the incidence of transient parathyroid function. Total thyroidectomy has certain advantages in the treatment of multiple nodular goiter.