全腔镜下甲状腺乳头状癌并发症Meta分析

Meta-analysis of Complications of Papillary Thyroid Carcinoma Under Full Laparoscopic Surgery

目的分析国内外全腔镜手术与传统开放性手术治疗甲状腺乳头状癌术中清扫淋巴结数目及术后并发症,探讨全腔镜术后患者并发症发生情况。方法本文通过中国知网(CNKI)、中国生物医学文献数据库(CBM)、PubMed、万方数据库、Embase、Web of Science和Cochrane Library等数据库,检索关键词“甲状腺”“甲状腺肿瘤”“全腔镜”“分化型甲状腺癌”“Thyroid carcinoma”“Papillary Thyroid Carcinoma”“Video-Assisted”“EndoscopicThyroidectomy”。结果纳入了2012年~2020年统计源及核心期刊发表高质量的国内文献11篇全腔镜治疗分化型甲状腺癌及2007年~2018年国内4篇、国外8篇全腔镜治疗甲状腺乳头状癌方面的文章进行Meta分析。最终纳入23篇文献,其中腔镜组1223例,开放组2399例。腔镜组清扫淋巴结数目多于开放组(WMD=-0.45,95%CI:-0.08~-0.09,Z=2.47,P=0.01);两组术后暂时性低钙血症发生率的相比,差异无统计学意义(OR=0.81,95%CI:0.64~1.03,Z=1.69,P=0.09);腔镜组术后暂时性喉返神经损伤的可能性多于开放组(OR=1.97,95%CI:1.13~3.43,Z=4.64,P=0.00);两组术后肿瘤复发率的相比,差异无统计学意义(OR=0.55,95%CI:0.23~1.35,Z=1.30,P=0.195),两组术后血肿形成的可能性相比,差异无统计学意义(OR=0.81,95%CI:0.64~1.03,Z=0.73,P=0.47)。结论全腔镜治疗甲状腺乳头状癌手术产生的术后并发症少,具有一定的安全性,术中清扫淋巴结较开放性手术彻底,降低了术后甲状腺乳头状癌患者复发及转移风险。

Objective To analyze the number of lymph node dissections and postoperative complications in the treatment of papillary thyroid carcinoma by full laparoscopic surgery and traditional open surgery at home and abroad.To discuss the complications of patients after total laparoscopy.Methods In this paper,through the China Knowledge Network(CNKI),China Biomedical Literature Database(CBM),PubMed,Wanfang Database,Embase,Web of Science and Cochrane Library,etc.Key words"thyroid","thyroid tumor","full endoscopy","differentiated thyroid carcinoma","Thyroid carcinoma","Papillary Thyroid Carcinoma","Video-Assisted",and"EndoscopicThyroidectomy".Results Included 11 high-quality domestic articles published in statistical sources and core journals from 2012 to 2020 and 4 domestic articles from 2007 to 2018 in the treatment of differential.Meta-analysis of 8 foreign articles on the treatment of papillary thyroid carcinoma with full laparoscopic surgery.Finally,23 articles were included,including 1223 cases in the endoscopy group and 2399 cases in the open group.The number of lymph nodes in the endoscopy group was more than that in the open group(WMD=-0.45,95%CI:-0.08--0.09,Z=2.47,P=0.01);There was no statistically significant difference in the incidence of postoperative transient hypocalcemia between the two groups(OR=0.81,95%CI:0.64-1.03,Z=1.69,P=0.09);The possibility of transient recurrent laryngeal nerve injury in the laparoscopy group was more than that in the open group(OR=1.97,95%CI:1.13-3.43,Z=4.64,P=0.00);There was no statistically significant difference in the tumor recurrence rate between the two groups after surgery(OR=0.55,95%CI:0.23-1.35,Z=1.30,P=0.195).Compared with the possibility of postoperative hematoma formation in the two groups,The difference was not statistically significant(OR=0.81,95%CI:0.64-1.03,Z=0.73,P=0.47).Conclusion The full laparoscopic treatment of papillary thyroid carcinoma has fewer postoperative complications and is safe.Intraoperative lymph node dissection is more thorough than open surgery,which reduces the risk of recurrence and metastasis in patients with postoperative papillary thyroid carcinoma.