摘要
目的 比较甲状腺全切或次全切除术与患侧腺叶加峡叶切除术分别作为初治TNM分期为Ⅰ和Ⅱ期分化型甲状腺癌的手术方式时术后复发率及并发症发生率的差异.方法 对1972-2012年期间Pubmed、Medline、万方数据库、中国生物医学文献数据库、中国学术期刊全文数据库和中国知网数据库进行相关文献检索.根据纳入及删除标准,将采用上述两类术式并比较了术后复发及并发症情况的随机对照或病例对照研究17篇文献纳入,其中涉及复发率13篇,涉及并发症11篇.采用RevMan5.0软件包对纳入文献进行荟萃分析（Meta分析）.结果 13个关于复发率的研究中,总的病例数为3511例,复发414例,总复发率为11.59％,其中全切或次全切除组（试验组）150例,复发率6.51％；腺叶加峡叶切除组（对照组）264例,复发率为21.83％.两组相比较,比值比（OR）及其95％的可信区间（95％ CI）为0.26[0.21,0.33],Z值为11.33,P＜0.01,可见试验组复发率显著低于对照组.11个关于并发症的研究中,总病例数为2388例,有166例术后出现各种并发症,并发症发生率为6.95％.其中试验组109例,并发症发生率为8.52％；对照组57例,并发症发生率为5.15％.两组相比较,OR值及其95％CI为3.63[2.47,5.33],Z值为6.58,P＜0.01,试验组并发症发生率显著高于对照组.结论 Ⅰ和Ⅱ期分化型甲状腺癌采用甲状腺全切或次全切除术可能减少术后复发机会,但术后并发症的发生率较高；而腺叶加峡叶切除术的术后并发症发生率较低,但却可能增加复发的风险.
Objective To compare the total thyroidectomy or subtotal resection and gland lobe and isthmus tobectomy as initial treatment to TNM stage Ⅰ and Ⅱ differentiated thyroid cancer.The difference between recurrence rate and surgical complications were analysed.Methods The literatures published between 1972-2012 were searched in Pubmed,Medline,Wanfang database,Chinese Biomedical Literature Database,Chinese scientific Journals database and China National Knowledge Infrastructure.According to the inclusion and deletion criteria,17 articles were included to compare the postoperative recurrence and complications in randomized controlled or case-control studies,involving 13 articles in recurrence rate and 11 articles in complications.RevMan5.0 software package was used to perform meta-analysis.Results Thirteen articles involved with the recurrence rate,the total case number was 3511.Among these cases,414recurred,overall recurrence rate was 11.59%,of which,150 recurred cases in total or subtotal resection group （experimental group）,the recurrence rate was 6.51% ; 264 recurred cases in gland lobe lobectomy plus isthmus group （control group）,the recurrence rate was 21.83%.Comparing the two groups,the odds ratio （OR） and their 95% confidence interval （95% CI） was 0.26[0.21,0.33],Z value was 11.33,P 〈0.01,which showed that the recurrence rate in experimental group was significantly lower than that in control group.Eleven articles involved with the complications,the total case number was 2388,166 cases had postoperative complications.The complication rate was 6.95%,of which,109 eases in experimental group,the complication rate was 8.52% ; 57 eases in control group,the complication rate was 5.15%.Compared with the two groups,OR values and their 95% CI was 3.63 [2.47,5.33],Z was 6.58,P 〈 0.01,the experimental group had significantly higher incidence of complications.Conclusion For Ⅰ and Ⅱ differentiated thyroid cancer,total thyroidectomy or subtotal resection may reduce the chance of recurrence,but the postoperative complications is higher; while gland lobe and isthmus lobectomy has lower postoperative complications,but may increase the risk of relapse.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2013年第10期834-839,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
2012年四川省卫生厅科学研究资助项目（120027）
2013年四川省科技厅公关项目（12013SZ0017）
关键词
甲状腺肿瘤
甲状腺切除术
肿瘤复发
局部
手术后并发症
META分析
Thyroid neoplasms
Thyroidectomy
Neoplasm recurrence, local
Postoperative complications
Meta-analysis [Publication type]
