甲状腺全切除术治疗多发结节性甲状腺肿的Meta分析

目的：系统评价甲状腺全切除术(包含近全切除术)对比次全切除术治疗多发结节性甲状腺肿的疗效和安全性。方法：计算机检索Cochrane Library、PubMed、Embase、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库等，检索时间截止2013年11月。纳入甲状腺全切除术(包含近全切除术)对比次全切除术治疗多发结节性甲状腺肿的随机对照试验，由两名研究员分别独立提取数据进行文献质量评价，并用RevMan5.1软件进行Meta分析。结果：最终纳入符合标准的相关文献7篇，共2 192例患者。Meta分析结果显示：与甲状腺次全切相比，全切除术(包含近全切除术)后结节复发率低(OR=0.13，95% CI：0.07~0.22，P<0.001)，短暂性甲状旁腺功能减低发生率较高(OR=2.33，95% CI：1.72~3.17，P<0.001)，而在永久性喉返神经麻痹(OR=0.81，95% CI：0.24~2.74，P=0.74)及永久性甲状旁腺功能减低(OR=2.94，95% CI：0.48~18.11，P=0.24)方面二者之间差异无统计学意义。结论：与甲状腺次全切除术相比，全切除术(包含近全切除术)治疗多发结节性甲状腺肿的术后结节复发率明显降低，并未增加永久性并发症。

Meta-analysis of total thyroidectomy for #br# multinodular goiter

Objective: To systematically evaluate the efficiency and safety of total thyroidetomy (including near-total tyhroidectomy) versus subtotal thyroidectomy for multinodular goiter.Methods: The literatures were searched from Cochrane Library, PubMed, Embase, Chinese Biological Medical Datebase, Chinese National Knowledge Infrastructure, and Chinese Science and Technology Journal Full-text Database as of November 2013. We included all randomizad controlled trials on total (including near-total) versus subtotal thyroidectomy in the treatment of multinodular goiter. The collecting of data and quality assessment were respectively completed by 2 researchers. RevMan5.1 software was used for Meta-analysis.Results: We collected 7 literatures conforming to the standard, incuding 2 192 patients. The Meta-analysis outcomes showed that total thyroidectomy was associated with lower nodule recurrence rate (OR=0.13, 95% CI: 0.07-0.22, P<0.001) and higher in transient hypoparathyroidism rate (OR=2.33, 95% CI: 1.72-3.17, P<0.001). However, no statistical difference was seen comparing total and subtotal thyroidectomy in permanent recurrent laryngeal nerve paralysis rate (OR= 0.81, 95% CI: 0.24-2.74, P=0.74) and permanent hypoparathyroidism rate (OR=2.94, 95% CI: 0.48-18.11, P=0.24).Conclusion: Nodule recurrence rate of total thyroidectomy for multinodular goiter is lower than subtotal thyroidectomy and does not increase permanent complications.