无充气经腋窝入路传统腔镜与机器人甲状腺切除术疗效的Meta分析

A meta-analysis of curative effect comparison between traditional endoscopic and robotic thyroidectomy by gasless transaxillary approach

目的:通过Meta分析比较无充气经腋窝入路传统腔镜甲状腺切除术(ET)与相同入路机器人甲状腺切除术(RT)的疗效。方法:制定检索策略,检索万方、CNKI、Embase、Cochrane Library、PubMed数据库中关于两种术式的相关文献,结合纳入与排除标准筛选ET与RT的回顾性临床对照研究,采用Meta分析的方法对所获得的研究进行比较。纳入比较的指标包括手术时间、淋巴结清扫数量、住院时间、甲状旁腺功能减退、暂时性喉返神经损伤、术后引流量。使用RevMan 5.4软件进行分析。结果:共纳入5篇文献、1 752例患者。RT组术中淋巴结清扫数量多于ET组(WMD=-0.55,95%CI=-0.89~-0.20,P=0.002,I2=54%),术后暂时性甲状旁腺功能减退发生率高于ET组(OR=0.25,95%CI=0.14~0.43,P<0.00001,I2=41%)。RT组无永久性甲状腺功能减退发生,ET组发生1例。两组均无永久性喉返神经损伤。两组手术时间(WMD=-20.81,95%CI=-41.89~0.27,P=0.05,I2=95%)、住院时间(WMD=-0.06,95%CI=-0.22~0.11,P=0.50,I2=54%)差异无统计学意义。结论:RT的优势在于清扫中央组淋巴结,在喉返神经损伤、住院时间方面两种术式相近。

Objective:To compare the safety and efficacy of traditional gasless transaxillary endoscopic thyroidectomy(ET)and gasless transaxillary robotic thyroidectomy(RT)by meta-analysis.Methods:A retrieval strategy was developed to search Wanfang,China national knowledge infrastructure,Embase,Cochrane Library,and PubMed database for literatures on the two surgical methods.Retrospective clinical controlled studies of ET and RT were screened according to inclusion and exclusion criteria,and the results were compared by meta-analysis.The indicators included operation time,number of lymph node dissection,hospital stay,temporary,temporary recurrent laryngeal nerve injury,postoperative drainage volume.RevMan 5.4 software was used to analyze the data.Results:Five studies with a total of 1752 patients were included.Compared with ET group,the number of intraoperative lymph node dissection(WMD=-0.55,95%CI=-0.89~-0.20,P=0.002,I2=54%)and temporary postoperative hypoparathyroidism(OR=0.25,95%CI=0.14~0.43,P<0.00001,I2=41%)in RT group was more.No permanent hypoparathyroidism occurred in RT group and one case occurred in ET group.There was no permanent recurrent laryngeal nerve injury in either group.There was no significant difference in operation time(WMD=-20.81,95%CI=-41.89~0.27,P=0.05,I2=95%)and hospital stay(OR=-0.06,95%CI=-0.22~0.11,P=0.50,I2=45%)between the two groups.Conclusions:The advantage of RT lies in the dissection of central lymph nodes.RT is similar with ET in terms of recurrent laryngeal nerve injury and hospital stay.