Sun Rong-hao, Li Chao, Fan Jin-chuan, Wang Wei, Li Chun-hua, Xu Yi-quan, Li Xiao-xia
Department of Head and Neck Surgery, Sichuan Cancer Hospital Cancer Institute, Chengdu 610041, China.
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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 Oct;48(10):834-9.
To compare the total thyroidectomy or subtotal resection and gland lobe and isthmus lobectomy as initial treatment to TNM stage I and II differentiated thyroid cancer. The difference between recurrence rate and surgical complications were analysed.
The literatures published between 1972-2012 were searched in Pubmed, Medline, Wanfang database, Chinese Biomedical Literature Database, Chinese scientific Journals database and China National Knowledge Infrastructure. According to the inclusion and deletion criteria, 17 articles were included to compare the postoperative recurrence and complications in randomized controlled or case-control studies, involving 13 articles in recurrence rate and 11 articles in complications.RevMan5.0 software package was used to perform meta-analysis.
Thirteen articles involved with the recurrence rate, the total case number was 3511. Among these cases, 414 recurred, overall recurrence rate was 11.59%, of which, 150 recurred cases in total or subtotal resection group (experimental group), the recurrence rate was 6.51%; 264 recurred cases in gland lobe lobectomy plus isthmus group (control group), the recurrence rate was 21.83%. Comparing the two groups, the odds ratio (OR) and their 95% confidence interval (95%CI) was 0.26 [0.21,0.33], Z value was 11.33, P < 0.01, which showed that the recurrence rate in experimental group was significantly lower than that in control group.Eleven articles involved with the complications, the total case number was 2388, 166 cases had postoperative complications. The complication rate was 6.95%, of which, 109 cases in experimental group, the complication rate was 8.52%; 57 cases in control group, the complication rate was 5.15%. Compared with the two groups, OR values and their 95%CI was 3.63 [2.47, 5.33], Z was 6.58, P < 0.01, the experimental group had significantly higher incidence of complications.
For I and II differentiated thyroid cancer, total thyroidectomy or subtotal resection may reduce the chance of recurrence, but the postoperative complications is higher; while gland lobe and isthmus lobectomy has lower postoperative complications, but may increase the risk of relapse.
比较甲状腺全切除术或次全切除术与腺叶加峡部切除术作为TNM I期和II期分化型甲状腺癌初始治疗方法的效果。分析复发率和手术并发症之间的差异。
在Pubmed、Medline、万方数据库、中国生物医学文献数据库、中国科学期刊数据库和中国知网中检索1972年至2012年间发表的文献。根据纳入和排除标准，纳入17篇文章，比较随机对照或病例对照研究中的术后复发和并发症情况，其中13篇涉及复发率，11篇涉及并发症。使用RevMan5.0软件包进行荟萃分析。
13篇文章涉及复发率，病例总数为3511例。其中，414例复发，总体复发率为11.59%，其中全切除或次全切除组（实验组）有150例复发，复发率为6.51%；腺叶加峡部切除组（对照组）有264例复发，复发率为21.83%。两组比较，比值比（OR）及其95%置信区间（95%CI）为0.26[0.21,0.33]，Z值为11.33，P<0.01，表明实验组的复发率显著低于对照组。11篇文章涉及并发症，病例总数为2388例，166例有术后并发症。并发症发生率为6.95%，其中实验组109例，并发症发生率为8.52%；对照组57例，并发症发生率为5.15%。两组比较，OR值及其95%CI为3.63[2.47,5.33]，Z为6.58，P<0.01，实验组并发症发生率显著更高。
对于I期和II期分化型甲状腺癌，甲状腺全切除术或次全切除术可能会降低复发几率，但术后并发症较高；而腺叶加峡部切除术术后并发症较低，但可能会增加复发风险。
