甲状腺手术中显露喉返神经的安全性Meta分析

目的系统评价甲状腺手术中显露喉返神经的安全性。方法根据预定纳入、排除标准,在中国知网(CNKI)、万方数据库(Wanfang Data)、维普数据库(VIP)和中国生物医学文献数据库(CBM)等中文数据库中对甲状腺手术中显露喉返神经的文献进行检索。检索时限均从建库至2013年12月。采用Rewman 5.1软件对资料进行Meta分析。结果共纳入符合标准的文献20篇(均为中文),共计25 435例患者,其中试验组10 592例,对照组14 843例,试验组为甲状腺手术术中显露喉返神经,对照组为甲状腺手术术中不显露喉返神经。Meta分析结果显示:试验组喉返神经损伤的总发生率显著低于对照组(RR=0.40,95%CI 0.28⁰.58,P<0.05);试验组暂时性喉返神经损伤的发生率与对照组无统计学差别(RR=0.75,95%CI 0.520.58,P<0.05);试验组暂时性喉返神经损伤的发生率与对照组无统计学差别(RR=0.75,95%CI 0.52¹.10,P>0.05);试验组永久性喉返神经损伤的发生率显著低于对照组(RR=0.19,95%CI0.111.10,P>0.05);试验组永久性喉返神经损伤的发生率显著低于对照组(RR=0.19,95%CI0.11⁰.32,P<0.001),试验组甲状旁腺损伤的发生率与对照组无统计学差异(RR=1.01,95%CI0.650.32,P<0.001),试验组甲状旁腺损伤的发生率与对照组无统计学差异(RR=1.01,95%CI0.65¹.57,P>0.05)。结论与非显露喉返神经的甲状腺手术相比,显露喉返神经的甲状腺手术能有效地减少术中喉返神经的损伤,值得临床继续应用和推广。

Safety of exposure of recurrent laryngeal nerve in thyriod surgery:a Meta-analysis

Objective To evaluate the safety of expose the recurrent laryngeal nerve in thyroid operation.Methods Based on inclusion , exclusion criteria , searched thyroid operation of exposure of recurrent nerve laryngeal Chinese literature in China Knowledge Resource Integrated Database （CNKI）, Wanfang （Wanfang Data） database, VIP database （VIP） and Chi-nese biomedical literature database （CBM.Time limitation was from established to 2013 Decembe.Meta-analysis of data were performed using Revman .1 softwar.Results According to the criteria, 20 papers （all Chinese） were included, a to-tal of 25 435 patients were enrolled , including 10 592 cases in test group , 14 843 cases in the control group , the test group re-ceived thyroid surgery with exposure of the recurrent laryngeal nerve , and the control group received the thyroid surgery without exposure of the recurrent laryngeal nerve.The results of Meta-analysis showed that the experimental group ’ s incidence rate of laryngeal recurrent nerve injury in thyroid surgery was significantly lower than that of control group （RR=0.40, 95%CI .28-.58, P 〈0.05）; experimental group temporary recurrent laryngeal nerve injury rate had no statistical differences from control group （RR=0.75, 95%CI .52-.10, P〉0.05）;the test group permanent recurrent laryngeal nerve injury inci-dence was significantly lower than the control group （RR=0.19, 95%CI .11-.32, P 〈0.001）, parathyroid injury inci-dence of test group and control group showed no significant difference （RR=0.01, 95%CI .65-.57, P〉0.05.Con-clusion Compared with non-exposure of recurrent laryngeal nerve in thyroid surgery , exposure of recurrent laryngeal nerve in thyroid surgery can reduce the recurrent laryngeal nerve injury during operation effectively , it is worthy of clinical promotion and application.