内镜手术入路对甲状腺全切除术的比较:系统回顾和贝叶斯网络荟萃分析。

IF 1.5 3区 医学 Q3 SURGERY
Gland surgery Pub Date : 2025-01-24 Epub Date: 2025-01-20 DOI:10.21037/gs-24-424
Tengjiang Long, Junlei Li, Yuquan Yuan, Zeyu Yang, Peng Xu, Bin Pan, Yiceng Sun, Supeng Yin, Chengzhi Zhao, Fan Zhang
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引用次数: 0

摘要

背景:不同的内镜下甲状腺全切除术入路用于治疗分化型甲状腺癌,引起了临床对综合评价这些入路优缺点的关注。在这项研究中,我们旨在通过网络荟萃分析来比较不同的内镜手术入路对甲状腺全切除术的影响,揭示其各自的优势和局限性。方法:检索PubMed、Medline、Cochrane Library、Web of Science和EMBASE数据库,检索时间从建站到2024年3月。进行两两元分析和贝叶斯网络元分析。累积排序曲线下的曲面(SUCRA)用于确定每种手术入路获得最佳个体结果的概率。结果:纳入21项研究,共4361例患者。根据SUCRA值,经口内镜入路(EOA)在所有内镜手术入路中检索到的淋巴结(LNs)数量最多(SUCRA =0.59)。微创视频辅助入路(MIVAA)较其他内镜手术入路明显缩短手术时间(SUCRA =0.77)。MIVAA在降低永久性甲状旁腺功能低下发生率(SUCRA =0.81)和控制术中出血(SUCRA =0.77)方面被评为最有效的手术入路。内镜下经腋窝无气入路(EGAA)有效缩短住院时间(SUCRA =0.95),降低一过性甲状旁腺功能低下发生率(SUCRA =0.74)。内镜下双侧乳晕(EBAA)入路是预防喉返神经麻痹最有效的手术入路(SUCRA =0.92)。结论:内镜下全甲状腺切除术的手术效果与开放式甲状腺切除术相当。在手术时间、术中出血量、永久性甲状旁腺功能减退率等方面,MIVAA优于其他内镜手术入路。EOA在检索中表现出显著的优势。EBAA对RLN的保护效果较好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of endoscopic surgical approaches for total thyroidectomy: a systematic review and Bayesian network meta-analysis.

Background: Different approaches to endoscopic total thyroidectomy are emerging for the treatment of differentiated thyroid cancer, raising clinical concerns about comprehensively evaluating the strengths and weaknesses of these approaches. In this study, we aimed to conduct a network meta-analysis to compare different endoscopic surgical approaches to total thyroidectomy, revealing their respective advantages and limitations.

Methods: PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2024. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to determine the probability that each surgical approach for the best individual outcome.

Results: Twenty-one studies comprising 4,361 patients were included. Based on the SUCRA value, the endoscopic transoral approach (EOA) retrieved the highest number of lymph nodes (LNs) (SUCRA =0.59) among all endoscopic surgical approaches. The minimally invasive video-assisted approach (MIVAA) significantly shortened the operative time (SUCRA =0.77) compared to other endoscopic surgical approaches. MIVAA ranked as the most effective surgical approach for reducing the rate of permanent hypoparathyroidism (SUCRA =0.81) and controlling intraoperative bleeding (SUCRA =0.77). The endoscopic gasless transaxillary approach (EGAA) effectively shortened the hospital stay (SUCRA =0.95) and reduced the rate of transient hypoparathyroidism (SUCRA =0.74). The endoscopic bilateral areola (EBAA) approach ranked as the most effective surgical approach for preventing recurrent laryngeal nerve (RLN) palsy (SUCRA =0.92).

Conclusions: The surgical outcomes of endoscopic total thyroidectomy are comparable to those of open thyroidectomy. MIVAA was superior to other endoscopic surgical approaches in terms of operative time, intraoperative bleeding volume, and permanent hypoparathyroidism rate. EOA demonstrated a significant advantage in LNs retrieval. EBAA was superior in protecting the RLN.

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来源期刊
Gland surgery
Gland surgery Medicine-Surgery
CiteScore
3.60
自引率
0.00%
发文量
113
期刊介绍: Gland Surgery (Gland Surg; GS, Print ISSN 2227-684X; Online ISSN 2227-8575) being indexed by PubMed/PubMed Central, is an open access, peer-review journal launched at May of 2012, published bio-monthly since February 2015.
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