预防性中央颈部清扫术在临床淋巴结阴性甲状腺乳头状癌患者中的有效性和安全性：一项荟萃分析。

The effectiveness and safety of prophylactic central neck dissection in clinically node-negative papillary thyroid carcinoma patients: A meta-analysis.

机构信息

Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China.

出版信息

Front Endocrinol (Lausanne). 2023 Jan 17;13:1094012. doi: 10.3389/fendo.2022.1094012. eCollection 2022.

OBJECTIVE

This meta-analysis was performed to evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) in patients with clinically node-negative (cN0) papillary thyroid carcinoma.

MATERIALS AND METHODS

A meta-analysis of the literature was performed using the key words "papillary thyroid carcinomas" and "lymph node ecisions" for searches of electronic databases. Complications such as transient hypocalcemia, permanent hypocalcemia, transient and permanent hypoparathyroidism, transient and permanent vocal cord paralysis, transient recurrent and permanent recurrent laryngeal nerve injury, and local recurrence were pooled by meta-analysis. Stata17.0 was used to carry out the meta-analysis.

RESULTS

Data were extracted from 15 studies. In the present review, the group of patients who had total thyroidectomy (TT) with PCND had a lower local recurrence than the group with TT alone (OR 0.22, 95% CI 0.10-0.45, P = 0.000), whereas the incidence of permanent hypocalcemia (OR 4.24, 95% CI 1.05-17.22, P = 0.043) and transient hypoparathyroidism (OR 2.14, 95% CI 1.34-3.42, P =0.001) were higher. No significant differences were recorded in the incidence of other complications: transient hypocalcemia (OR 2.24, 95% CI 0.77-6.51, P = 0.138), permanent hypoparathyroidism (OR 1.70, 95% CI 0.89-3.27, P = 0.111), transient vocal cord paralysis (OR 1.48, 95% CI 0.78-2.83, P = 0.231), permanent vocal cord paralysis (OR 1.44, 95% CI 0.53-3.94, P = 0.477), transient recurrent laryngeal nerve injury (OR 1.47, 95% CI 0.93-2.32, P = 0.102) and permanent recurrent laryngeal nerve injury (OR 1.24, 95% CI 0.56-2.74, P = 0.587) between the two groups.

CONCLUSION

Compared with TT alone, TT with PCND was more effective in reducing local recurrence without increasing the risk of recurrent laryngeal nerve, thyroid and vocal cord, except for hypocalcemia and transient hypoparathyroidism. Therefore, we believe that TT with PCND should be recommended for patients with cN0 PTC.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD4202 2355078.

目的

本荟萃分析旨在评估预防性中央颈部清扫术（PCND）在临床淋巴结阴性（cN0）甲状腺乳头状癌患者中的有效性和安全性。

材料与方法

使用关键词“甲状腺乳头状癌”和“淋巴结切除术”对电子数据库进行文献检索，进行荟萃分析。通过荟萃分析汇集了诸如短暂性低钙血症、永久性低钙血症、暂时性和永久性甲状旁腺功能减退、暂时性和永久性声带麻痹、暂时性和永久性喉返神经损伤以及局部复发等并发症。使用 Stata17.0 进行荟萃分析。

结果

从 15 项研究中提取数据。在本综述中，行甲状腺全切除术（TT）联合 PCND 的患者局部复发率低于仅行 TT 的患者（OR 0.22，95%CI 0.10-0.45，P = 0.000），但永久性低钙血症（OR 4.24，95%CI 1.05-17.22，P = 0.043）和暂时性甲状旁腺功能减退症（OR 2.14，95%CI 1.34-3.42，P = 0.001）的发生率更高。其他并发症的发生率无显著差异：短暂性低钙血症（OR 2.24，95%CI 0.77-6.51，P = 0.138）、永久性甲状旁腺功能减退症（OR 1.70，95%CI 0.89-3.27，P = 0.111）、暂时性声带麻痹（OR 1.48，95%CI 0.78-2.83，P = 0.231）、永久性声带麻痹（OR 1.44，95%CI 0.53-3.94，P = 0.477）、暂时性喉返神经损伤（OR 1.47，95%CI 0.93-2.32，P = 0.102）和永久性喉返神经损伤（OR 1.24，95%CI 0.56-2.74，P = 0.587）。