无充气腋窝入路腔镜甲状腺手术治疗甲状腺癌临床疗效的Meta分析

The clinical efficacy of endoscopic thyroidectomy for thyroid carcinoma in gasless axillary approach:a meta-analysis

目的:通过Meta分析系统评价无充气腋窝入路腔镜甲状腺癌根治术治疗甲状腺癌的临床疗效。方法:系统性检索PubMed、Embase、万方、维普、中国知网、中国生物医学数据库等中英文数据库,收集2020年1月至2023年8月有关无充气腋窝入路腔镜甲状腺手术与传统手术治疗甲状腺癌的临床对照试验文献,由2名独立研究者根据纳入、排除标准进行文献筛选、资料提取、质量评价,使用RevMan 5.3软件对结局指标进行Meta分析。结果:最终纳入6项随机对照试验、10项回顾性临床对照试验,共1863例患者。与传统开放甲状腺癌根治术相比,无充气腋窝入路腔镜甲状腺癌根治术的术后并发症发生率低[OR=0.41,95%CI(0.30,0.55),P<0.00001],患者切口美容满意度高[OR=3.94,95%CI(2.75,5.63),P<0.00001],手术时间[MD=47.23,95%CI(39.61,54.85),P<0.00001]、术后引流量[MD=56.22,95%CI(42.46,69.98),P<0.00001]、引流管放置时间[MD=0.53,95%CI(0.05,1.01),P=0.03]、术后住院时间[MD=0.95,95%CI(0.58,1.32),P<0.00001]、住院费用[MD=2169.70,95%CI(1786.01,2553.38),P<0.00001]增加,差异有统计学意义;两组术中出血量、淋巴结清扫数量差异无统计学意义(P>0.05)。结论:无充气腋窝入路腔镜甲状腺癌根治术与传统甲状腺手术治疗甲状腺癌均是安全、可行的,无充气腋窝入路腔镜甲状腺癌根治术在术后并发症、切口美容满意度方面具有优势。

Objective:To systematically evaluate the clinical efficacy of endoscopic thyroidectomy for thyroid carcinoma in the gasless axillary approach by meta-analysis.Methods:A systematic search was conducted for relevant literatures in PubMed,Embase,Wanfang,VIP,CNKI,CBM and other databases.All databases were searched to collect the clinical controlled trials articles on endoscopic thyroidectomy in the gasless axillary approach and conventional open thyroidectomy for thyroid carcinoma from Jan.2020 to Aug.2023.Two independent investigators performed literature screening,data extraction and quality evaluation according to the inclusion and exclusion criteria.Meta-analysis was performed on the outcome indicators using RevMan 5.3 software.Results:A total of 16 relevant articles involving 1863 patients were included,containing 6 articles of randomized controlled trials and 10 articles of retrospective clinical c ontrolled trials.The meta-analysis showed that compared with conventional open thyroidectomy,the rate of postoperative complications in endoscopic thyroidectomy via the gasless axillary approach was less[OR=0.41,95%CI(0.30,0.55),P<0.00001],and the rate of incision cosmetic satisfaction[OR=3.94,95%CI(2.75,5.63),P<0.00001],the operation time[MD=47.23,95%CI(39.61,54.85),P<0.00001],the postoperative drainage volume[MD=56.22,95%CI(42.46,69.98),P<0.00001],the postoperative drainage tube placement time[MD=0.53,95%CI(0.05,1.01),P=0.03],the postoperative hospital stay[MD=0.95,95%CI(0.58,1.32),P<0.00001]and the hospitalization expenses[MD=2169.70,95%CI(1786.01,2553.38),P<0.00001]of endoscopic thyroidectomy group were more,the differences were statistically significant.However,there were no significant differences between the two groups in the intraoperative blood loss and the number of lymph nodes removed(P>0.05).Conclusions:Endoscopic thyroidectomy in the gasless axillary approach and conventional open thyroidectomy are both safe and feasible in the treatment of thyroid carcinoma.Endoscopic t hyroidectomy in the gasless axillary approach has advantages in the postoperative complications and incision cosmetic satisfaction.