分化型甲状腺峡部癌手术治疗Meta分析

Surgiacl treatment for primary differentiated thyroid isthmus carcinoma:a mata analysis

目的系统评价分化型甲状腺峡部癌(differentiated thyroid isthmus carcinoma,DTIC)全切及非全切的疗效,为临床手术方式选择提供循证依据。方法通过万方数据库、中国生物医学文献数据库、中国学术期刊全文数据库和维普数据库检索中文文献,PubMed、Embase、Cochrane databases检索英文文献,检索时间为1980年1月~2021年12月。按照检索策略进行文献检索,检索到相关文献664篇,符合纳入排除标准文献共9篇,多为病例对照研究。结果甲状腺全切(全切组)无复发生存率(recurrence-free survival,RFS)高于非全切组(93.84%vs 81.28%,Z=2.88,P=0.004),全切组复发率低于非全切组(4.23%vs 9.71%,Z=2.87,P=0.004)。全切组永久性甲状旁腺功能低下发生率高于非全切组(3.92%vs 0.84%,Z=2.03,P=0.04),全切组神经损伤与非全切组无统计学差异(Z=0.31,P=0.78)。结论激进的手术方式可能增加甲状旁腺功能损伤,但甲状腺全切组复发率低于非全切组。因此在针对此类患者手术方式的制定需要衡量风险以及获益,在保障肿瘤预后的基础上减少并发症的发生。

OBJECTIVE To assess and compare the curative effect of patients undergoing total thyroidectomy and non-total resection of differentiated thyroid isthmus cancer treatment,and providing evidence for the selection of clinical surgical methods.METHODS Use WANFANG Data,SinoMed,Cnki and VIP database to search Chinese literature.Use PubMed,Cochrane library and Embase databases to search English literature,and limit the search date and time from January 1980 to December 2021.The literature search was carried out according to the detection strategy,and 664 related papers were retrieved,and a total of 9 papers that met the inclusion and exclusion criteria were all case-control studies.RESULTS The recurrence-free survival rate of the total resection group was higher than that of the non-total resection group(93.84%vs 81.28%,Z=2.88,P=0.004),the recurrence rate of the total thyroidectomy group was lower than that of the non-total resection group(4.23%vs 9.71%,Z=2.87,P=0.004).The incidence of permanent hypoparathyroidism in the total resection group was higher than that of the non-total resection group(3.92%vs 0.84%,Z=2.03,P=0.04),there was no statistical difference between nerve damage in the total thyroidectomy group and the non-total resection group(Z=0.31,P=0.78).CONCLUSION The analysis in this article shows that aggressive surgical methods may increase parathyroid function damage,which is significantly different from the control group,but the total thyroidectomy group recurrence rate is lower than that of the non-total resection group.Therefore,the development of surgical methods for such patients needs to measure the risks and benefits,and reduce the occurrence of complications on the basis of ensuring the prognosis of the tumor.