一项比较甲状腺切除术中LigaSure小切口与钳夹结扎技术或超声刀聚焦技术疗效的荟萃分析。
A meta-analysis comparing the outcomes of LigaSure Small Jaw versus clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.
作者信息
Zhang Lei, Li Namei, Yang Xuemei, Chen Jie
机构信息
Department of Endocrinology, Sichuan Academy of Medical Science & Sichuan Provincial Hospital Department of Infection Disease, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
出版信息
Medicine (Baltimore). 2017 Mar;96(11):e6141. doi: 10.1097/MD.0000000000006141.
BACKGROUND
LigaSure (LS) Small Jaw is a surgical hemostasis equipment that is newly introduced in thyroid surgery. The objective of this study is to assess the short-term efficacy and safety outcomes of LS Small Jaw compared with clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.
METHODS
A literature search was performed in the PubMed and Embase databases (until June 12, 2016) that reported the comparisons between LS Small Jaw and other techniques in thyroidectomy. Quality assessments were performed according to The Cochrane Collaboration's risk of bias tool and a modification of the Newcastle-Ottawa Scale in randomized controlled trials (RCTs) and non-RCTs, respectively. All statistical analyses were conducted using RevMan 5.3.
RESULTS
Finally, 7 studies with 813 patients were included into the meta-analysis, and all included studies were comparable with moderate-to-high quality. There was significant reduced operative time in LS Small Jaw, compared with clamp-and-tie (mean difference [MD] = -17.49, 95% confidence interval [CI]: -22.20 to 12.77, P < 0.00001) or Harmonic Focus Scalpel (MD = -2.29, 95% CI: -3.19 to 1.39, P < 0.00001). Besides, other perioperative outcomes including intraoperative blood loss and postoperative blood loss favored LS Small Jaw compared with clamp-and-tie. In terms of complications, less-temporary hypocalcemia rate was observed in LS Small Jaw compared with clamp-and-tie (odds ratio [OR] = 0.49, 95% CI: 0.27-0.90, P = 0.02), although no significant difference was detected compared with Harmonic Focus Scalpel (OR = 0.47, 95% CI: 0.14-1.56, P = 0.22). Other complications such as length of hospital stay, permanent hypocalcemia, temporary or permanent recurrent laryngeal nerve palsy, and hematomas were not significant.
CONCLUSION
In conclusion, LS Small Jaw is more favorable than clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.
背景
LigaSure（LS）小颌器械是甲状腺手术中新引入的一种手术止血设备。本研究的目的是评估在甲状腺切除术中，与钳夹结扎技术或超声聚焦刀相比，LS小颌器械的短期疗效和安全性结果。
方法
在PubMed和Embase数据库（截至2016年6月12日）中进行文献检索，以获取报道LS小颌器械与其他技术在甲状腺切除术中比较的研究。分别根据Cochrane协作网的偏倚风险工具以及对随机对照试验（RCT）和非RCT的纽卡斯尔-渥太华量表的修改进行质量评估。所有统计分析均使用RevMan 5.3进行。
结果
最终，7项研究共813例患者被纳入荟萃分析，所有纳入研究的质量均为中到高质量。与钳夹结扎（平均差[MD]=-17.49，95%置信区间[CI]：-22.20至-12.77，P<0.00001）或超声聚焦刀（MD=-2.29，95%CI：-3.19至-1.39，P<0.00001）相比，LS小颌器械的手术时间显著缩短。此外，与钳夹结扎相比，包括术中失血和术后失血在内的其他围手术期结果更有利于LS小颌器械。在并发症方面，与钳夹结扎相比，LS小颌器械的暂时性低钙血症发生率较低（比值比[OR]=0.49，95%CI：0.27-0.90，P=0.02），尽管与超声聚焦刀相比未检测到显著差异（OR=0.47，95%CI：0.14-1.56，P=0.22）。其他并发症，如住院时间、永久性低钙血症、暂时性或永久性喉返神经麻痹以及血肿，差异均无统计学意义。
结论
总之，在甲状腺切除术中，LS小颌器械比钳夹结扎技术或超声聚焦刀更具优势。
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