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目的评价机器人甲状腺切除术(robotic thyroidectomy,RT)与腔镜甲状腺切除术手术(endoscopic thyroidectomy,ET)联合中央区淋巴结清扫术治疗淋巴结阴性甲状腺恶性肿瘤的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Wan Fang Data、CBM、CNKI,查找有关RT与ET治疗淋巴结阴性高分化甲状腺恶性肿瘤(DTC)的随机或非随机同期对照试验,检索时限截止到2015年12月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入6个研究,共计4614例患者。Meta分析结果显示:与ET组比较,RT组比住院时长比较差异有统计学意义[MD=-0.08,95%CI(-0.06,-0.01),P=0.03],中央区淋巴结清扫数目比较,其差异有统计学意义[MD=0.58,95%CI(0.25,0.92),P<0.05],在术后积液,短暂性低钙血症,永久性低钙血症,短暂性喉返神经麻痹,永久性喉返神经损伤、乳糜漏比较差异无统计学意义。结论机器人甲状腺切除术作为新型手术方式,具有独特优势,术后并发症并不高于腔镜甲状腺手术。
Objective To evaluate the effectiveness and safety of robotic thyroidectomy (RT) and endoscopic thyroidectomy (ET) combined with central lymph node dissection in the treatment of lymph node-negative thyroid malignancies. Methods We searched PubMed, EMbase, The Cochrane Library, Wan Fang Data, CBM and CNKI for randomized or nonrandomized controlled trials of RT and ET for the treatment of lymph node-negative and differentiated thyroid malignant tumors (DTCs). The search period is up to 2015 December. After two reviewers independently screened the literature for inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies, Meta-analysis was performed using RevMan 5.2 software. The results eventually included 6 studies, a total of 4614 patients. Meta analysis showed that there was significant difference between RT group and hospitalization time in ET group (MD = -0.08, 95% CI, -0.06, -0.01, P = 0.03). The number of lymph node dissection in central area was significantly higher than that in ET group The difference was statistically significant [MD = 0.58, 95% CI (0.25, 0.92), P <0.05], postoperative effusions, transient hypocalcemia, permanent hypocalcemia, transient laryngeal nerve Paralysis, permanent recurrent laryngeal nerve injury, chylous leakage was no significant difference. Conclusions Robotic thyroidectomy has unique advantages as a new surgical modality. Postoperative complications are not higher than endoscopic thyroidectomy.