经胸前入路腔镜手术与传统手术治疗甲状腺癌的疗效及安全性Meta分析

The safety and efficacy of endoscopic thyroidectomy via anterior chest approach versus conventional open thyroid surgery for thyroid cancer:a meta-analysis

目的:评价腔镜手术(胸前入路)与传统手术(颈前开放)治疗甲状腺癌的疗效及安全性。方法:检索PubMed、Embase、Web of Science、Cochrane Library数据库中关于甲状腺癌两种术式对比的文献,检索时间定为建库至2020年3月。使用Downs and black工具评价纳入文献的质量。结果:纳入8篇英文文献,共涉及1 174例患者。经胸前入路腔镜甲状腺癌手术(腔镜组)的手术时间[MD=54.51,95%CI(40.02,68.99)]、术后引流量[MD=38.97,95%CI(13.29,64.64)]、引流时间[MD=1.08,95%CI(0.20,1.96)]均超过传统开放甲状腺癌手术(开放组),差异有统计学意义(P<0.05)。两组淋巴结清扫数量[MD=-0.38,95%CI(-0.90,0.14)]、术中出血量[MD=-0.67,95%CI(-11.65,10.31)]、住院时间[MD=0.16,95%CI(-0.09,0.41)]、疼痛评分[MD=-0.26,95%CI(-0.62,0.10)]差异均无统计学意义(P>0.05)。两组甲状旁腺损伤[OR=0.38,95%CI(0.10,1.48)]、喉返神经损伤[OR=1.42,95%CI(0.78,2.59)]、喉上神经损伤[OR=0.73,95%CI(0.14,3.80)]、淋巴瘘[OR=0.32,95%CI(0.09,1.13)]、皮下血肿[OR=1.13,95%CI(0.24,5.29)]发生率差异无统计学意义(P>0.05)。随访发现,两组术后复发率相近(腔镜组4%vs.开放组3%)。结论:两种手术入路的临床有效性、安全性、复发率相近,对于有微创要求的甲状腺癌患者可根据情况考虑经胸前入路行腔镜手术,同时仍需开展更多高质量的研究。

Objective:To evaluate the efficacy and safety of endoscopic surgery(anterior chest approach)and traditional surgery(open thyroidectomy)for thyroid cancer.Methods:The literatures on the operative comparison of thyroid cancer in PubMed,Embase,Web of Science and Cochrane Library databases before Mar.2020 were searched.The quality of these studies was evaluated by the scale of Downs and Black.Results:Eight English literatures were included,involving a total of 1174 patients.In terms of clinical effectiveness,the operative time of the anterior chest approach[MD=54.51,95%CI(40.02,68.99)],postoperative drainage volume[MD=38.97,95%CI(13.29,64.64)],and drainage time[MD=1.08,95%CI(0.20,1.96)]exceeded open surgery.There were no statistically significant differences in number of lymph node harvested[MD=-0.38,95%CI(-0.90,0.14)],intraoperative blood loss[MD=-0.67,95%CI(-11.65,10.31)],hospital stay[MD=0.16,95%CI(-0.09,0.41)]and pain score[MD=-0.26,95%CI(-0.62,0.10)](P>0.05).And the incidence of parathyroid injury[OR=0.38,95%CI(0.10,1.48)],recurrent laryngeal nerve injury[OR=1.42,95%CI(0.78,2.59)],and superior laryngeal nerve injury[OR=0.73,95%CI(0.14,3.80)],lymphatic fistula[OR=0.32,95%CI(0.09,1.13)],subcutaneous hematoma[OR=1.13,95%CI(0.24,5.29)]were not significantly different between the two groups(P>0.05).After follow-up,it was found that the recurrence rate was similar between the two groups(4%in the endoscopic group and 3%in the open group).Conclusions:The results of the two surgical approaches are similar in terms of clinical effectiveness,safety and recurrence rate.Thus the anterior chest approach is the better option for patients with cosmetic concerns,and more high-quality studies are still needed.