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1、腔镜下甲状腺手术与传统开放性甲状腺手术临床疗效对比的Meta分析【摘要】目的:系统评价腔镜下甲状腺切除术与开放性手术的有效性和安全性。方法:釆用Cochrane系统评价方法,用计算机检索1999-2015年PubMed、Embase>中国生物医学文献数据库(CBM)>中文期刊全文数据库(CNKT)和维普数据库(VTP)中腔镜下甲状腺手术与传统开放性手术临床疗效对比的对照研究,采用RevMan5.3软件进行Meta分析。结果:共纳入11个临床研究(总计1326例甲状腺疾病患者),Meta分析结果显
2、示,与开放性手术相比,腔镜下甲状腺切除术未能缩短手术时间(WMD=9・99,95%C1:-3.98—23.95,P二0.16),未能减少手术引流量(WD=6.10,95%CI:-5.73-17.92,P二0.31),但能明显减少术中出血量(WMD二-22.96,95%CI:-28.88—17.04,P<0.00001),缩短术后恢复时间(WMD二-0.62,95%CI:-0.98〜-0.26,P二0.0007),减少术后并发症的发生(0R=0.35,95%CI:0.24〜0.53,P<0.000
3、01)。结论:腔镜下甲状腺手术临床疗效较传统开放性手术相比,具有术中出血少,术后恢复快及并发症发生率低等优势。因本研究纳入的病例均为非随机的对照试验,且质量不高,具有一定的局限性,因此上述结论尚需谨慎对待,有必耍开展更多高质量、大样本的随机对照试验研究对此问题进行深入研究。【关键词】腔镜下甲状腺手术;开放性甲状腺手术;Meta分析AMetaAnalysisofClinicalEffectComparisonofEndoscopicThyroidectomyandTraditionalOpenOp
4、eration/WANGZheng-qiang,LAIDa-nian.//MedicalInnovationofChina,2016,13(20):113-117[Abstract】Objective:Toevaluatetheefficiencyandsafetyofendoscopicandopensurgicalthyroidectomyinpatientswiththyroiddiseases・Method:Dataaboutcontrolledclinicaltiralsofcompa
5、ringendoscopicthyroidectomywithopensurgicalthyroidectomyforthyroiddiseaseswasretrievedfromelectronicaldatabasesofPubmed,Embase,CBM,CNK1andVIPbasedonthemethodguidelinesforsystematicreviewsofCochranefrom1999to2015.RevMan5.3softwarewasusedfordataanalysi
6、s.Result:Atotalof11literatures(1326casesforthyroiddiseases)wereselected.TheMetaanalysisshowedthatcomparedtoopensurgicalthyroidectomy,theendoscopicthyroidectomyfailedtoshortentheoperationtime(WMD二9.99,95%CI:-3.98-23.95,P=0.16),reducedtheintraoperative
7、drainage(WMD二6.10,95%CI:-5.73-17.92,P二0.31),butcouldsignificantlyreducetheintraoperativebloodloss(WMD二-22.96,95%CI:-28.88—17.04,P<0.00001),shortenthepostoperativerecoverytime(WMD二-0.62,95%CT:-0.98--0.26,P=0.0007),reducedthepostoperativecomplications(
8、0R=0.35,95%CI:0.24-0.53,P〈0.00001).Conclusion:Comparedwithtraditionalopensurgery,clinicaleffectofendoscopicthyroidectomyhavesomeadvanlages,suchaslessbloodloss,shortertimeofpostoperativerecovery,lowrateofpostoperativecomplications・However,thetrailsava