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目的客观评价腔镜辅助下甲状腺切除术治疗甲状腺疾病的有效性及安全性。方法计算机检索MEDLINE、EMBASE、PubMed、CBM及Cochrane图书馆2006年第2期;手工检索有关中文杂志。纳入腔镜辅助下甲状腺切除术与传统手术治疗甲状腺疾病的随机对照试验,并对其方法学质量进行评价。用Revman4.2.8软件进行统计分析。结果共纳入4个随机对照试验,包括164例病人。Meta分析结果显示,腔镜辅助甲状腺切除术与传统甲状腺切除术相比,有较好的美容效果[WMD1.05,95%CI(0.47,1.62)];术后疼痛较轻[WMD-8.20,95%CI(-11.60,-4.80)];并发症发生率二者差异无统计学意义[RR1.90,95%CI(0.65,5.54)];腔镜辅助手术耗时较长[WMD18.96,95%CI(17.23,20.69)]。结论腔镜辅助手术具有美容、微创的优势,但适应证范围较窄,手术时间较长。治疗甲状腺癌尚有待进一步开展随机对照研究以评价疗效。

Video-assisted thyroidectomy in treating thyroid diseases:a Meta-analysis

Objective To evaluate the availability and safety of video-assisted thyroidectomy(VAT) for treating thyroid diseases(benign thyroid nodular diseases and "low risk" thyroid cancer).Methods The electronic databases such as MEDLINE,EMBASE,PubMed,Cochrane Library,CBM,CNKI were searched;we handsearched some relevant Chinese periodicals.The quality of included trials was evaluated by two estimators.Meta-analysis in the homogenous studies was made.RevMan 4.2.8 software was used for statistical analysis.Results Four randomized controlled trials(164 patients) undergoing video-assisted versus conventional thyroidectomy(CT) were included.The results of meta-analysis indicated that statistically significant differences were observed between the two operative procedures in cosmetic result[WMD1.05,95%CI(0.47,1.62)];postoperative pain [WMD-8.20,95%CI(-11.60,-4.80)];operative time[WMD18.96,95%CI(17.23,20.69)].The only no statistical significance was observed in complication rate[RR1.90,95%CI(0.65,5.54)].Conclusion Cosmetic result and postoperative pain in VAT are superior to that in CT.Operative time is longer in VAT than in CT.No significant differences are found between the two procedures in complication rate.There is insufficient evidence to demonstrate that VAT is also feasible for malignant thyroid diseases.More high quality,multi-center large-scale randomized controlled trials are required.