Mirghani Hyder Osman, Albalawi Ibrahim Altedlawi
Hyder Osman Mirghani, Professor of Internal Medicine, Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia.
Ibrahim Altedlawi Albalawi, Professor of Surgical Oncology, Department of Surgery, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia.
Pak J Med Sci. 2024 Dec;40(11):2726-2731. doi: 10.12669/pjms.40.11.9712.
Remote scarless surgeries have been developed for cosmetic reasons; literature showed that remote endoscopic surgeries were superior to conventional thyroidectomy. However, no researchers have compared the transoral thyroidectomy vestibular approach and transareolar approach regarding cosmetic outcomes and postoperative pain score. This meta-analysis assessed the same among patients with papillary microcarcinoma, thyroid disease, and small-size papillary carcinoma.
We searched PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Library from the date of the first inception up to January 2024. The general keywords used are trans-areolar thyroidectomy, trans-oral thyroidectomy vestibular approach, scar-less thyroidectomy, remote thyroidectomy, pain score, and cosmetic effects. The MeSH terms "mouth", "areola", "nipples", "vestibular", "oral", "endoscopes", "endoscopic", and "thyroid" were used. Out of the 389 studies and 114 remained after the removal of duplication, from them, 22 full texts were screened, and only 10 studies were included in the final meta-analysis.
The tansoral thyroidectomy vestibular approach showed better cosmetic outcomes compared to the trans-areolar approach, odd ratio, 1.26, 95% CI, 0.53-1.99. However, no significant statistical difference was found regarding postoperative pain score, odd ratio, -0.11, 95% CI, -0.26-0.04, and central lymph node dissection, odd ration, 1.52, 95% CI, -0.14-3.17.
The transoral endoscopic thyroidectomy vestibular approach was better compared to the trans-areolar approach in terms of cosmetic outcomes, no differences were evident regarding pain score and central lymph node dissection. Further larger well-controlled studies assessing operative and postoperative outcomes are needed.
出于美容目的已开展了远程无瘢痕手术；文献表明远程内镜手术优于传统甲状腺切除术。然而，尚无研究人员比较经口甲状腺切除术前庭入路和经乳晕入路在美容效果和术后疼痛评分方面的差异。本荟萃分析评估了乳头状微小癌、甲状腺疾病和小尺寸乳头状癌患者中的上述情况。
我们检索了从首次收录日期至2024年1月的PubMed MEDLINE、科学网、Scopus和考克兰图书馆。使用的通用关键词为经乳晕甲状腺切除术、经口甲状腺切除术前庭入路、无瘢痕甲状腺切除术、远程甲状腺切除术、疼痛评分和美容效果。使用了医学主题词“口腔”“乳晕”“乳头”“前庭”“经口”“内窥镜”“内镜的”和“甲状腺”。在389项研究中，去除重复项后还剩114项，从中筛选了22篇全文，最终纳入荟萃分析的仅有10项研究。
与经乳晕入路相比，经口甲状腺切除术前庭入路显示出更好的美容效果，优势比为1.26，95%置信区间为0.53 - 1.99。然而，在术后疼痛评分方面未发现显著统计学差异，优势比为 - 0.11，95%置信区间为 - 0.26 - 0.04，在中央淋巴结清扫方面也无显著差异，优势比为1.52，95%置信区间为 - 0.14 - 3.17。
就美容效果而言，经口内镜甲状腺切除术前庭入路优于经乳晕入路，在疼痛评分和中央淋巴结清扫方面无明显差异。需要进一步开展更大规模的严格对照研究来评估手术和术后结果。
