热消融与开放手术治疗甲状腺微小乳头状癌的Meta分析

Meta-analysis of thermal ablation and open surgery on the treatment of papillary thyroid microcarcinoma

目的分析热消融与开放手术在甲状腺微小乳头状癌(PTMC)治疗中的差异,评估两种治疗的优势与安全性。方法从PubMed、Embas、Cochran Library、CNKI、万方等数据库中检索截至2020年4月有关热消融和开放手术治疗甲状腺微小乳头状癌对比研究的相关文献,采用RevMan5.3软件进行Meta分析。结果从528篇文献中选出9篇符合标准的文献,其中热消融526例,开放手术470例,经过Meta分析,热消融组出血量、操作时间、住院时间均少于开放手术组[MD=-17.30,95%CI(-23.99,-10.61),P<0.00001;MD=-42.97,95%CI(-53.80,-32.14),P<0.00001;MD=-3.71,95%CI(-4.53,-2.90),P<0.00001],声嘶、呛咳、手足麻木等相关并发症的发生率亦较低[OR=0.30,95%CI(0.14,0.61),P=0.001;OR=0.36,95%CI(0.16,0.82),P=0.01;OR=0.12,95%CI(0.03,0.47),P=0.002]。结论相比传统开放手术,热消融治疗甲状腺微小乳头状癌具有创伤小、并发症少、恢复快的优点,但在治疗中应严格把握适应证。

Objective To analyze the difference between thermal ablation and open surgery on the treatment of papillary thyroid microcarcinoma(PTMC),and to evaluate the advantages and safety of the two methods.Methods Relevant literatures on the comparative study of thermal ablation and open surgery were searched from PubMed,Embase,Cochran Library,CNKI,Wanfang as of Apr 2020.Meta-analysis was conducted by Rev Man 5.3 software.Results A total of 9 studies were selected from 528 articles,Meta-analysis showed that bleeding volume,procedure time and hospitalization duration of thermal ablation group were significant fewer than that of open surgery group[MD=-17.30,95%CI(-23.99,-10.61),P<0.00001;MD=-42.97,95%CI(-53.80,-32.14),P<0.00001;MD=-3.71,95%CI(-4.53,-2.90),P<0.00001],and complications such as hoarseness,cough and hypocalcemia in thermal ablation group were also less than open surgery group[OR=0.30,95%CI(0.14,0.61),P=0.001;OR=0.36,95%CI(0.16,0.82),P=0.01;OR=0.12,95%CI(0.03,0.47),P=0.002].Conclusion The thermal ablation treatment has superiority of less trauma,less complication and faster rehabilitation compared with open surgery.However,the treatment indication should be under strict condition.