摘要
目的:对机器人辅助甲状腺切除术(RT)与腔镜甲状腺切除术(ET)在分化型甲状腺癌(DTC)治疗中的临床效果及安全性进行系统性评估。方法:通过检索PubMed、Embase、Cochrane Library、中国知网、万方数据和维普资讯等数据库,收集2022年12月前发表关于对比RT与ET治疗DTC效果的随机对照研究或回顾性病例对照研究,并对相关参考文献进行补充筛选。依据预设纳入及排除标准筛选文献后,进行质量评估和数据提取。采用RevMan 5.4软件,基于固定或随机效应模型完成Meta分析的森林图绘制。结果:本研究共纳入9项回顾性研究,涉及5423例患者。分析结果表明RT组与ET组在基线特征(年龄、BMI、肿瘤大小等)方面无显著差异;两组在术后并发症方面(包括暂时性与永久性低钙血症、喉返神经损伤、皮下血肿/积液、乳糜漏、气管损伤及臂丛神经损伤等9项指标)比较,差异均无统计学意义(P>0.05);RT组总手术时间显著长于ET组(P<0.05),但二者手术操作时间相当(P>0.05);RT组在淋巴结检出数量(P<0.05)和术后引流量(P<0.05)方面优于ET组;两组术后住院时间和肿瘤复发率无显著差异(P>0.05)。结论:RT与ET均为治疗DTC的安全有效术式,但RT在淋巴结清扫彻底性上更具优势,而ET手术效率更高。临床决策需结合患者个体情况、疾病分期及医疗条件而定。
Objective:To systematically evaluate the clinical efficacy and safety of robot-assisted thyroidectomy(RT)versus endoscopic thyroidectomy(ET)in the treatment of differentiated thyroid carcinoma(DTC).Methods:PubMed,Embase,Cochrane Library,CNKI,Wanfang Data,and VIP databases were searched for randomized controlled trials or retrospective case-control studies comparing RT and ET for DTC published before December 2022.References were supplemented for additional screening.After screening based on predefined inclusion/exclusion criteria,quality assessment and data extraction were performed.Forest plots for Meta-analysis were generated using RevMan 5.4 software based on fixed or random-effects models.Results:Nine retrospective studies involving 5423 patients were included.No significant differences were observed between RT and ET groups in baseline characteristics(age,BMI,tumor size,etc.).No statistically significant differences were found in postoperative complications,including transient/permanent hypocalcemia,recurrent laryngeal nerve injury,subcutaneous hematoma/effusion,chylous leakage,tracheal injury,and brachial plexus injury(P>0.05).RT had significantly longer total operative time than ET(P<0.05),but no difference in surgical procedure time(P>0.05).RT outperformed ET in lymph node retrieval(P<0.05)and postoperative drainage volume(P<0.05).No significant differences were found in postoperative length of hospital s tay or tumor recurrence rate(P>0.05).Conclusion:Both RT and ET are safe and effective surgical approaches for treating DTC,with RT outperforming ET in lymph node dissection,but ET has higher surgical efficiency than RT.Individual patient conditions,disease stage,and medical resources should be considered in clinical decision-making.
作者
杜成周
高笑欣
陈鹏
周倩
许鑫鑫
何天啸
李洪涛
DU Chengzhou;GAO Xiaoxin;CHEN Peng;ZHOU Qian;XU Xinxin;HE Tianxiao;LI Hongtao(Department of General Surgery,the 940th Hospital of PLA Joint Logistics Support Force,Lanzhou 730050,China)
出处
《机器人外科学杂志(中英文)》
2025年第12期2098-2107,共10页
Chinese Journal of Robotic Surgery
基金
“G计划”高层次人才培养工程(2024-G1-1)。
