内镜手术治疗甲状腺乳头状癌价值的荟萃分析

目的评价内镜辅助下甲状腺切除术治疗甲状腺乳头状癌的有效性和安全性。方法检索2010年12月前公开发表的内镜手术与传统开放手术疗效和安全性的前瞻性对照试验。按照纳入和排除标准筛选后提取疗效及安全性指标，进行荟萃分析。结果共纳入3项试验，包括298例患者。荟萃分析结果显示，内镜辅助下甲状腺切除术与传统开放手术相比，术后早期血清甲状腺球蛋白（TG）水平、术后”。I治疗前甲状腺瘤床吸碘率均无统计学意义95％CI（-6．43，11．95），P=0．56；95％CI（-1．47，1．42），P=0．981；术后并发症总体发生率、喉返神经麻痹及甲状旁腺功能减低的发生率均相似，无统计学意义95％CI（0．56，3．61），P=0．45；95％CI（O．58，14．11），P=0．20，95％CI（0．25，2．67），P=0．74]。结论内镜辅助下甲状腺切除术治疗低风险甲状腺乳头状癌的疗效及其安全性不劣于传统开放手术，仍有待大样本前瞻性随机对照试验结果的支持。

Meta-analysis of efficacy and safety after video-assisted thyroidectomy for papillary thyroid cancer

Objective To evaluate the curative effects and safety of video-assisted thyroidectomy(VAT) in the treatment of papillary thyroid cancer.Methods Medical journals published in different countries were retrieved to search the literatures related to prospective controlled trials on the comparison between the effects and safety of VAT and conventional thyroidectomy(CT) in the treatment of papillary thyroid cancer that were published before the end of 2010.The valid literatures were selected based on the inclusion and exclusion criterias,the information about efficacy and safety was extracted from the literatures and then appraised by meta-analysis.Results Three articles,total for 298 cases,were included in the meta-analysis.It showed that the early postoperative serum thyroglobulin(TG) measurement and the thyroid bed 131I uptake before 131I therapy between VAT and CT group has no significant difference 95%CI(-6.43,11.95),P = 0.56;95%CI(-1.47,1.42),P = 0.98];The overall incidence of postoperative complications、recurrent laryngeal nerve paralysis and hypoparathyroidism were similar with no significant difference between the two groups 95%CI(0.56,3.61),P = 0.45;95%CI(0.58,14.11),P = 0.20;95%CI(0.25,2.67),P = 0.74 ].Conclusion From the perspective of efficacy and safety,VAT is not inferior to CT in the treatment for papillary thyroid cancer,but it is remained to be supported by the results of large sample prospective randomized controlled trials.