Wang Yichao, Liu Kai, Xiong Junjie, Zhu Jingqiang
From the Departments of *Thyroid and Breast Surgery, †Cardiology, and ‡Pancreatic Surgery, West China Hospital, Sichuan University, Guo Xue Rd 37, Chengdu, Sichuan Province, China.
J Craniofac Surg. 2015 Mar;26(2):464-8. doi: 10.1097/SCS.0000000000001449.
The objective of this study was to conduct a meta-analysis to assess the safety and efficacy of total endoscopic thyroidectomy (TET) versus conventional open thyroidectomy (COT) for papillary thyroid microcarcinoma with regard to short-term clinical outcomes.
MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials in the Cochrane Library between January 1996 and July 2014 were searched to identify relevant comparative studies. Pooled weighted mean differences (WMD) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either fixed or random-effects models. The perioperative outcomes were evaluated.
Five eligible nonrandomized studies were included, involving 1004 patients: 475 were TET and 529 were COT. Meta-analysis results revealed that TET group had a significantly longer operative time (WMD, 48.15; 95% CI, 27.54-68.75; P < 0.00001), compared with the COT group. While analyzing the number of removed lymph nodes, 4 studies were included. The TET group had a less number of removed lymph nodes (WMD, -0.68; 95% CI, -1.20 to -0.15; P = 0.01). There were no significant differences in terms of hospital stay, transient recurrent laryngeal nerve palsy, permanent recurrent laryngeal nerve palsy, transient hypocalcemia, and permanent hypocalcemia.
Total endoscopic thyroidectomy appears to be a much feasible safe surgical procedure for papillary thyroid microcarcinoma in selected patients.
本研究的目的是进行一项荟萃分析，以评估全内镜甲状腺切除术（TET）与传统开放性甲状腺切除术（COT）治疗甲状腺微小乳头状癌的短期临床疗效及安全性。
检索1996年1月至2014年7月期间的MEDLINE、EMBASE、科学引文索引扩展版以及Cochrane图书馆中的Cochrane对照试验中心注册库，以确定相关的比较研究。使用固定效应模型或随机效应模型计算合并加权平均差（WMD）或比值比（OR）以及95%置信区间（CI）。对围手术期结局进行评估。
纳入了5项符合条件的非随机研究，涉及1004例患者：475例行TET，529例行COT。荟萃分析结果显示，与COT组相比，TET组手术时间显著更长（WMD，48.15；95%CI，27.54 - 68.75；P < 0.00001）。在分析切除淋巴结数量时，纳入了4项研究。TET组切除的淋巴结数量较少（WMD，-0.68；95%CI，-1.20至-0.15；P = 0.01）。在住院时间、短暂性喉返神经麻痹、永久性喉返神经麻痹、短暂性低钙血症和永久性低钙血症方面无显著差异。
对于部分选择的患者，全内镜甲状腺切除术似乎是一种可行且安全的手术方式，用于治疗甲状腺微小乳头状癌。
