机器人辅助甲状腺切除术和腔镜甲状腺切除术治疗cN0期分化型甲状腺癌的有效性、安全性Meta分析

摘要

目的：评价机器人甲状腺切除术（robotic thyroidectomy，RT）与腔镜甲状腺切除术手术（endoscopic thyroidectomy，ET）联合中央区淋巴结清扫术治疗淋巴结阴性甲状腺恶性肿瘤的有效性和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library、Wan Fang Data、CBM、CNKI，查找有关 RT 与 ET 治疗淋巴结阴性高分化甲状腺恶性肿瘤（ DTC）的随机或非随机同期对照试验，检索时限截止到2015年12月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后，采用 RevMan 5.2软件进行 Meta 分析。结果最终纳入6个研究，共计4614例患者。Meta 分析结果显示：与 ET 组比较，RT 组比住院时长比较差异有统计学意义[MD =-0.08，95% CI（-0.06，-0.01），P =0.03]，中央区淋巴结清扫数目比较，其差异有统计学意义[MD =0.58，95% CI（0.25，0.92），P <0.05]，在术后积液，短暂性低钙血症，永久性低钙血症，短暂性喉返神经麻痹，永久性喉返神经损伤、乳糜漏比较差异无统计学意义。结论机器人甲状腺切除术作为新型手术方式，具有独特优势，术后并发症并不高于腔镜甲状腺手术。%Objective To systematically evaluate the efficacy and safety of robotic thyroidectomy (RT)and endoscopic thyroidectomy( ET)in the treatment of cN0 differentiated thyroid carcinoma.Methods Randomized or non-randomized controlled trials of RT versus ET for the treatment of cN0 dif-ferentiated thyroid cancer(DTC)were screened via PubMed,EMbase,the Cochrane Library,WanFang, CBM and CNKI databases. Two reviewers independently screened literature,extracted data and evaluated the methodological quality according to the inclusion and exclusion criteria. The retrieval time was limited to December 2015. RevMan 5. 2 was used for Meta-analysis. Results Finally,6 studies were included (4614 patients). Results of Meta-analysis showed that there were significant differences in the length of hospital stay[MD = - 0. 08,95% CI( - 0. 06,- 0. 01),P = 0. 03]and the number of lymph node dis-section[MD = 0. 58,95% CI(0. 25,0. 92),P < 0. 05]between the groups. There were no significant differences in the postoperative effusion,transient hypocalcemia,permanent hypocalcemia,transient recur-rent laryngeal nerve palsy,permanent recurrent laryngeal nerve injury and chylous leakage between the groups. Conclusion As a new operation mode,robotic thyroidectomy has unique advantages and its com-plication rate is similar to the endoscopic thyroidectomy.