Department of General Surgery, The Second Affiliated Hospital of Shantou Medical College, Shantou, People's Republic of China.
Surg Today. 2012 Sep;42(9):835-41. doi: 10.1007/s00595-011-0100-x. Epub 2011 Dec 21.
To evaluate the clinical application of different surgical approaches for endoscopic thyroidectomy and provide more rational treatment criteria.
Collect all randomized controlled trials, multi-center studies, clinical controlled trials, clinical trials and other comparative studies of endoscopic thyroidectomy with a large sample size in different databases through an established search strategy, make a systematic analysis of all the included literature.
This study selected 12 publications for analysis from more than 800 articles: these included six publications describing cervical thyroidectomy (A) and six publications describing extra-cervical thyroidectomy (B). Conversion to open surgery occurred in 29 patients in group A and only 4 in group B (p < 0.001). The patients in group A experienced shorter hospital stays than patients in group B (1.90 ± 0.80 vs. 4.03 ± 0.99 days, p < 0.001), and there was shorter operating time in group A (p < 0.001). Hemorrhage occurred in 3 cases in group A and 8 cases in group B (p = 0.04), Seroma occurred in 25 cases in group B but in no cases in group A (p < 0.001). Postoperative cosmetic results evaluated by verbal response scales (VRS) registered showed: group A (3.35 ± 0.60) and group B (3.74 ± 0.50; p < 0.001). Other complications such as recurrent laryngeal nerve injury and hypocalcemia showed no significant differences.
Evaluation of the different surgical approaches for endoscopic thyroidectomy shows that the incidence of hemorrhage and seroma are higher in the extra-cervical group, but the rate of conversion to conventional open surgery is significantly higher in the cervical group. Furthermore, patients who undergo extra-cervical endoscopic thyroidectomy are associated with longer operating time and hospital stays; however, these studies suggest that the extra-cervical surgical approach for endoscopic thyroidectomy is preferable for dealing with more kinds of thyroid tumor and leaving no scars on neck.
评估内镜甲状腺切除术不同手术入路的临床应用，为临床提供更合理的治疗标准。
通过既定的检索策略，收集来自不同数据库的内镜甲状腺切除术的所有随机对照试验、多中心研究、临床对照试验、临床试验和其他大样本量的比较研究，并对所有纳入文献进行系统分析。
本研究从 800 多篇文章中选择了 12 篇文章进行分析：其中 6 篇描述了颈侧入路甲状腺切除术（A 组），6 篇描述了经胸乳入路甲状腺切除术（B 组）。A 组中转开放手术的患者有 29 例，B 组仅有 4 例（p<0.001）。A 组患者的住院时间短于 B 组（1.90±0.80 与 4.03±0.99 天，p<0.001），手术时间也更短（p<0.001）。A 组有 3 例出血，B 组有 8 例（p=0.04），B 组有 25 例血清肿，A 组无血清肿（p<0.001）。通过口头反应量表（VRS）评估的术后美容效果显示：A 组（3.35±0.60）和 B 组（3.74±0.50；p<0.001）。喉返神经损伤和低钙血症等其他并发症无显著差异。
对内镜甲状腺切除术不同手术入路的评估显示，颈侧入路组出血和血清肿的发生率较高，但颈前入路组中转传统开放手术的比例明显较高。此外，经颈侧内镜甲状腺切除术的患者手术时间和住院时间较长；然而，这些研究表明，颈侧入路内镜甲状腺切除术更适合处理多种甲状腺肿瘤，且颈部不留疤痕。
