摘要
目的 通过比较单纯行原发灶处理与同时加行中央区淋巴清扫术在初治分化型甲状腺癌后肿瘤复发率及并发症发生率的差异,探讨此类患者行中央区淋巴清扫的临床价值.方法 对1998年至2013年期间万方数据库、重庆维普数据库、中国生物医学文献数据库、中国知网数据库、Pubmed、Medline及北京康健西文生物医学期刊文献数据库进行相关文献检索.根据纳入及排除标准共纳入30篇文献,其中探讨了术后总并发症率的研究26组,低钙血症及喉返神经麻痹两大主要并发症的研究分别为26组和24组,随访1年以上的复发率相关的研究26组.采用RevMan5.0软件包对纳入文献进行荟萃分析.结果 涉及总并发症率的研究中实验组（加行中央区淋巴清扫术）较对照组（仅行原发灶处理）出现术后并发症的概率升高13.08％;OR值及95％ CI为2.32[2.02,2.67],经Z检验,Z值为11.80,P＜0.01.术后低钙血症的发生率在实验组升高了11.80％,OR值及95％ CI为2.58[2.21,3.02],Z=11.98,P＜0.01;而喉返神经麻痹的发生率在实验组和对照组都较低,分别为5.26％和3.95％,且实验组仅升高1.31％,OR值及95％ CI为1.22[0.94,1.58],Z=1.48,P=0.14.复发率方面,实验组降低了2.23％,OR值及95％ CI为0.78[0.63,0.97],经Z检验,Z值为2.35,P=0.03.结论 分化型甲状腺癌患者施行中央区淋巴清扫术可能降低复发风险,但同时增加了总并发症及低钙血症的发生率,而对喉返神经麻痹无明显影响.
Objective To compare the differences in recurrence rates and surgical complications between thyroidectomy alone and thyroidectomy combined with central neck dissection as initial treatments to differentiated thyroid cancer and evaluate the clinic significance of central neck dissection for these patients.Methods The literatures published in 1998-2013 were searched in Wanfang database,Chongqing VIP database,Chinese Biomedical Literature Database,China National Knowledge Infrastructure,Pubmed,Medline and Beijing Kangjian foreign medical journal full text service.According to the inclusion and deletion criteria,30 articles were included.Of them 26 articles involved in complications,hypocalcemia and recurrent laryngeal nerve palsy as two major complications were involved in 26 articles and 24 articles respectively,and 26 articles involved in recurrence rate.RevMan5.0 software package was used to perform meta-analysis.Results Total complication rate in experimental group （plus central neck dissection） was 13.08％ higher than that in control group （thyroidectomy only）,the odds ratio （OR） [95％ confidence interval （95％ CI）] was 2.32 [2.02,2.67],Z value was 11.80,P ＜ 0.01.Hypocalcemia in the experimental group was 11.80％ higher than that in control group,OR value [95％ CI] was 2.58[2.21,3.02],Z was 11.98,P ＜ 0.01.The rates of recurrent laryngeal nerve paralysis were low in both experimental group （5.26％） and control group（3.95％）,and OR value [95％ CI] was 1.22 [0.94,1.58],Z was 1.48,P =0.14.Recurrence rate in experimental group was 2.23％ lower than that in control group,OR value [95％CI] was 0.78 [0.63,0.97],Zwas 2.35,P=0.03.Conclusion Central compartment dissection as initial treatment to differentiated thyroid cancer may reduce the risk of recurrence,but increases the incidence of total complications and hypocalcemia,and has no significant effect on the rate of the recurrent laryngeal nerve paralysis.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2014年第2期157-164,共8页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
2013年四川省科技厅公关项目（12013SZ0017）
2012年四川省卫生厅科学研究资助项目（120027）
