经双侧腋窝乳晕入路机器人甲状腺切除术与传统开放手术对比的Meta分析

Comparison between robotic thyroidectomy in bilateral axillo-breast approach and conventional open thyroidectomy:a Meta-analysis

目的:比较经双侧腋窝乳晕入路机器人甲状腺切除术与传统开放手术治疗甲状腺疾病的临床效果、安全性及卫生经济学效益。方法:计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网数据库、维普数据库、万方数据库,检索时限为自建库至2021年1月,收集有关经双侧腋窝乳晕入路机器人甲状腺切除术与传统开放手术治疗甲状腺疾病对比的中英文文献,根据纳入与排除标准进行文献筛选、资料提取,根据纽卡斯尔—渥太华量表进行文献质量评价,采用Review Manager 5.3软件及Stata 15软件进行Meta分析。结果:经筛选后共纳入18篇文献、4127例患者,其中机器人组1576例,传统开放组2551例。Meta分析结果显示,与传统开放组相比,机器人组术后第1天疼痛评分低、术后美容满意度评分高,术后暂时性甲状旁腺功能减退发生率低,但手术时间长、住院费用高、中央区淋巴结清扫数量较少;两组术中出血量、术后引流量、住院时间、永久性甲状旁腺功能减退、暂时性喉返神经损伤、永久性喉返神经损伤、术后出血、皮下积液、切口感染、乳糜瘘、颈侧区淋巴结清扫数量、术后刺激性甲状腺球蛋白水平、术后刺激性甲状腺球蛋白水平<1.0 ng/mL的例数、肿瘤复发情况差异均无统计学意义。结论:经双侧腋窝乳晕入路机器人甲状腺切除术治疗甲状腺疾病的临床效果及安全性与传统开放手术相当,但美容满意度高、卫生经济学效益稍差。对于经济条件较好又具有强烈美容需求的患者,经双侧腋窝乳晕入路机器人甲状腺切除术是较好的治疗选择。

Objective:To compare of clinical efficacy,safety and economic benefits of health between robotic thyroidectomy in bilateral axillo-breast approach and conventional open thyroidectomy for thyroid diseases.Methods:PubMed,Embase,Cochrane Library,Web of Science,China Biology Medicine disc,China National Knowledge Infrastructure,VIP Database and Wanfang Database were searched by computer.The retrieval period was from the establishment of the database to Jan.2021.Chinese and English literatures on the comparison between robotic thyroidectomy in bilateral axillo-breast approach and conventional open thyroidectomy for thyroid diseases were collected.Literature screening and data extraction were conducted according to inclusion and exclusion criteria.The literature quality was evaluated according to the Newcastle-Ottawa scale.Review Manager 5.3 and Stata 15 software were used for Meta-analysis.Results:After screening,18 literatures were included.A total of 4127 patients were included,including 1576 patients in the bilateral axillo-breast approach robotic thyroidectomy group and 2551 patients in the conventional open thyroidectomy group.Results of the Meta-analysis showed that compared with conventional open thyroidectomy,bilateral axillo-breast approach robotic thyroidectomy had lower pain score on first day after surgery,higher postoperative cosmetic satisfaction score,lower incidence of temporary hypoparathyroidism,longer operation time,higher hospitalization costs,and fewer number of retrieved central lymph node.There were no statistically significant differences in intraoperative blood loss,postoperative drainage volume,hospital stay,permanent hypoparathyroidism,temporary recurrent laryngeal nerve injury,permanent recurrent laryngeal nerve injury,postoperative bleeding,subcutaneous effusion,incision infection,chyle leakage,number of retrieved lateral lymph nodes,postoperative stimulated thyroglobulin level,number of patients with postoperative stimulated thyroglobulin level<1.0 ng/mL,and postoperative recurrence.Conclusions:Based on the current research evidence,clinical efficacy and safety of robotic thyroidectomy in bilateral axillo-breast approach is comparable to the conventional open thyroidectomy in the treatment of thyroid diseases,but bilateral axillo-breast approach robotic thyroidectomy has higher cosmetic satisfaction and poorer economic benefits of health,it is a good treatment option for patients with better economic conditions and strong cosmetic needs.