微波消融与传统开放手术治疗甲状腺微小乳头状癌的安全性及近期疗效Meta分析

Meta-analysis of the safety and short-term efficacy of microwave ablation and traditional open surgeryin the treatment of papillary thyroid microcarcinomas

目的运用Meta分析系统评价微波消融和传统开放手术治疗甲状腺微小乳头状癌的疗效及安全性。方法确定检索策略、文献的纳入与筛选原则,分别检索Pubmed(Medline)、Cochrane Library、中国生物医学文献数据库(Sinomed)、中国知网(CNKI)、万方数据库中关于微波消融治疗甲状腺微小乳头状癌的随机对照研究,实验组为微波消融法治疗,对照组为传统开放手术治疗。检索时间跨度为2017年4月至2020年4月。运用RevMan 5.3统计软件进行Meta分析。结果纳入研究文献10篇,研究对象1307人,其中试验组669人,对照组638人。结果显示微波消融组和传统开放手术组的手术情况、术后并发症发生率、甲状腺激素水平和炎症因子水平的差异均具有统计学意义。相比之下,微波消融在以上方面的优势均较明显,肿瘤体积变化也非常明显。结论微波消融法在治疗微小甲状腺乳头状癌方面具有手术创伤小、恢复快、美观度高、手术并发症少等特点,但是该10项研究均为近3年研究,随访时间短,其远期效果还有待未来大样本、长期随访的RCT研究来证实。

Objective The meta-analysis system was used to evaluate the efficacy and safety of microwave ablation and traditional open surgery in the treatment of papillary thyroid microcarcinomas.Methods The search strategy,the principle of inclusion and screening of the literature were determined.A literature search of Pubmed(Medline),Cochrane Library,China Biomedical Literature Database(Sinomed),CNKI,and Wanfang Database was performed for microwave ablation treatment of papillary thyroid microcarcinomas in randomized controlled studies.The experimental group was treated with microwave ablation and the control group was treated with traditional open surgery.The search time span is from April 2017 to April 2020.Meta analysis was conducted using RevMan 5.3 statistical software.Results A total of 10 RCTs were included,with 1307 subjects,including 669 in the experimental group and 638 in the control group.The results showed that the differences between the microwave ablation group and the traditional open surgery group were statistically significant in terms of operative conditions,postoperative complication rates,thyroid hormone levels,and inflammatory factor levels.In contrast,the advantages of microwave ablation in the above aspects are more obvious,and the tumor volume changes are also very obvious.Conclusions Microwave ablation has the characteristics of minimally invasiveness,fast recovery,high aesthetics,and few surgical complications in the treatment of papillary thyroid microcarcinomas.However,the 10 RCTs are all studies in the past 3 years with short follow-up time,and the long-term effect remains to be confirmed by future large-sample,long-term follow-up RCT studies.