机器人甲状腺切除术与传统开放性甲状腺手术临床疗效的Meta分析

A Meta-Analysis of the Clinical Efficacy of Robotic Thyroidectomy and Conventional Open Thyroidectomy

摘要: 目的：系统评价机器人甲状腺切除术(Robotic thyroidectomy, RT)与传统开放性手术(Conventional open thyroidectomy, COT)治疗甲状腺疾病的临床有效性和安全性。方法：计算机检索Pubmed、EMbase数据库、the Cochrane Library、循证医学临床参考数据库和中国知网、万方、维普等数据库，检索时间为建立数据库至2022年4月，采用RevMan4.2软件进行Meta分析。结果：最终纳入13篇文献，共计6536例患者。Meta分析结果显示：与COT组比较，RT组手术时间比较差异有统计学意义[MD = 52.74, 95% CI (23.58, 81.91), P = 0.0004]，患者年龄比较，其差异有统计学意义[MD = −4.94, 95% CI (−7.99, −1.88), P = 0.002]，中央淋巴结清扫数目比较，其差异有统计学意义[MD = −1.76, 95% CI (−3.18, −0.34), P = 0.02]；在肿瘤直径、住院时间、术后6个月血清Tg测定水平、乳糜漏、短暂性低钙血症、永久性低钙血症、短暂性喉返神经损伤、永久性喉返神经损伤比较中，其差异无统计学意义(P > 0.05)。结论：机器人甲状腺切除术可以作为一种有效的手术方式，其术后并发症较COT相比无明显差异，且能在治疗的同时兼顾美容效果，提高患者的术后生活质量。

Abstract: Objective: To systematically evaluate the clinical efficacy and safety of robotic thyroidectomy (RT) and conven-tional open thyroidectomy (COT) in the treatment of thyroid disease. Methods: The computer was searched for Pubmed, EMbase database, the Cochrane Library, evidence-based medical clinical ref-erence database, and China Knowledge Network, Wanfang, Weipu and other databases. The search time was to establish the database until April 2022, and Meta analysis was performed using RevMan4.2 software. Results: A total of 13 literatures were included, with a total of 6536 patients. Meta analysis results show that compared with the COT group, the RT group has a statistically sig-nificant difference in surgical time [MD = 52.74, 95% CI (23.58, 81.91), P = 0.0004], and the age of the patients has a statistically significant difference [MD = −4.94, 95% CI (−7.99, −1.88), P = 0.002], compared with the number of central lymph node dissections, the difference is statistically signifi-cant [MD = −1.76, 95% CI (−3.18, −0.34), P = 0.02]; in tumor diameter, length of hospital stay, se-rum Tg measurement level 6 months after surgery, chyle leakage, transient hypocalcemia, perma-nent hypocalcemia, transient recurrent laryngeal nerve injury, permanent laryngeal recurrence, there was no significant difference in nerve injury comparison (P > 0.05). Conclusion: Robotic thy-roidectomy can be used as an effective surgical method. The postoperative complications are not significantly different from those of COT, and it can take into account the cosmetic effects while im-proving the quality of patients’ postoperative life.