甲状腺乳头状癌原发灶外科治疗的Meta分析
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摘要
目的:采用Meta分析的方法,比较甲状腺全切术(TT)和甲状腺部分切术(PT)治疗甲状腺乳头状癌患者的疗效,为临床手术方式的选择提供循证学依据。方法:严格制定纳入排除标准,采用机检和手工检索相结合,系统全面检索CNKI、万方和PubMed、central、CBM等数据库比较甲状腺全切术和甲状腺部分切术治疗甲状腺乳头状癌患者的相关文献,检索时间截止2013年12月31日。结果:按照检索策略进行文献检索,检索到相关文献4 630篇,符合纳入排除标准的文献共20篇,均为回顾性研究。喉返神经损伤率TT组、PT组分别为5.9%、2.0%[OR=0.39,95%CI(0.17~0.90),P<0.05];甲状旁腺损伤率TT组、PT组分别为4.9%、0.8%[OR=0.23,95%CI(0.08~0.68),P<0.01];10年生存率TT组、PT组分别为95.2%~100.0%、96.8%~99.2%[OR=0.03,95%CI(0~0.34)];未分期、未分组TT组、PT组术后复发率为4.7%、12.6%[OR=3.21,95%CI(1.57~6.57),P<0.01];Ⅰ期TT组、PT组术后复发率为4.9%、7.8%[OR=3.82,95%CI(1.07~13.66),P<0.05];Ⅱ期患者TT组、PT组术后复发率为0.5%、15.9%[OR=17.23,95%CI(4.03~73.73),P<0.01]。结论:甲状腺乳头状癌原发灶外科治疗术后均可取得较好的生存率,但甲状腺部分切除术喉返神经及甲状旁腺损伤率低。因此,甲状腺部分切除应该是相对早期甲状腺乳头状癌的较好选择;相对晚期的甲状腺乳头状癌可以选择甲状腺全切除术。
Objective:To assess and compare the two procedures,total thyroidectomy(TT)and partial thyroidectomy(PT),for papillary thyroid cancer in terms of associated injuries,postoperative complication,recurrence rate and survival,so as to provide a reference and basis for surgical procedure option of this disease.Method:Strictly specified into the exclusion criteria,the combination of computer retrieval and manual retrieval and retrieval systems such as CNKI,Wang Fan,PubMed,central,CBM database.Total thyroidectomy and partial thyroidectomy for the treatment of patients with thyroid papillary cancer related literature were compared,with the retrieval time until December 31,2013.Result:According to the retrieval strategy 4630 literatures were found,and 20 witch matched the exclusion criteria were left,all were retrospective study.TT and PT group of recurrent laryngeal nerve injury rate are 5.9%,2.0% respectively[OR=0.39,95%CI(0.17-0.90),P<0.05],TT and PT group of parathyroid injury rate are respectively 4.9%,0.8% respectively [OR=0.23,95%CI(0.08-0.68),P<0.01].The TT group of 10 years survival rate is 95.24%-100%,and the PT group is 96.8%-99.2% [OR=0.03,95%CI(0-0.34),P<0.01].Unstaged,unstaged TT group′postoperative recurrence rate is 4.7%,while PT group is 12.6%[OR=3.21,95%CI(1.57-6.57),P<0.01].Postoperative recurrence of stageⅠ TT group and PT group are 4.9%,7.8% respectively[OR=3.82,95%CI(1.07-13.66),P<0.05];The rate of stageⅡ TT group is 0.5%,while the rate of PT group is 15.9%[OR=17.23,95%CI(4.03-73.73),P<0.01].Conclusion:Different methods of primary thyroid papillary carcinoma surgical treatment can all obtaina good survival,but the rate of laryngeal recurrent nerve injury and parathyroid injury caused by partal throidectomy is relatively lower.As a result,partial thyroidectomy can be a good choice for early stage thyroid papillary carcinoma.
Objective:To assess and compare the two procedures,total thyroidectomy(TT)and partial thyroidectomy(PT),for papillary thyroid cancer in terms of associated injuries,postoperative complication,recurrence rate and survival,so as to provide a reference and basis for surgical procedure option of this disease.Method:Strictly specified into the exclusion criteria,the combination of computer retrieval and manual retrieval and retrieval systems such as CNKI,Wang Fan,PubMed,central,CBM database.Total thyroidectomy and partial thyroidectomy for the treatment of patients with thyroid papillary cancer related literature were compared,with the retrieval time until December 31,2013.Result:According to the retrieval strategy 4630 literatures were found,and 20 witch matched the exclusion criteria were left,all were retrospective study.TT and PT group of recurrent laryngeal nerve injury rate are 5.9%,2.0% respectively[OR=0.39,95%CI(0.17-0.90),P<0.05],TT and PT group of parathyroid injury rate are respectively 4.9%,0.8% respectively [OR=0.23,95%CI(0.08-0.68),P<0.01].The TT group of 10 years survival rate is 95.24%-100%,and the PT group is 96.8%-99.2% [OR=0.03,95%CI(0-0.34),P<0.01].Unstaged,unstaged TT group′postoperative recurrence rate is 4.7%,while PT group is 12.6%[OR=3.21,95%CI(1.57-6.57),P<0.01].Postoperative recurrence of stageⅠ TT group and PT group are 4.9%,7.8% respectively[OR=3.82,95%CI(1.07-13.66),P<0.05];The rate of stageⅡ TT group is 0.5%,while the rate of PT group is 15.9%[OR=17.23,95%CI(4.03-73.73),P<0.01].Conclusion:Different methods of primary thyroid papillary carcinoma surgical treatment can all obtaina good survival,but the rate of laryngeal recurrent nerve injury and parathyroid injury caused by partal throidectomy is relatively lower.As a result,partial thyroidectomy can be a good choice for early stage thyroid papillary carcinoma.
引文
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[14]HAIGH P I,URBACH D R,ROTSTEIN L E.Extent of thyroidectomy is not a major determinant of survival in low-or high-risk papillary thyroid cancer[J].Ann Surg Oncol,2005,12:81-89.
[15]VOUTILAINEN P E,SIIRONEN P,FRANSSILA K O,et al.AMES,MACIS,and TNM prognostic classifications in-papillary thyroid carcinoma[J].Anticancer Res,2003,23:4283-4288.
[16]MENDELSOHN A H,ELASHOFF D A,ABEMAYOR E,et al.Surgery for papillary thyroid carcinoma is lobectomy enough[J]?Arch Otolaryngol Head Neck Surg,2010,136:1055-1061.
[17]HUNDAHL S A,FLEMING I D,FREMGEN A M,et al.A National Cancer Data Base report on 53,856cases of thyroid carcinoma treated in the U.S.,1985-1995[see commetns][J].Am Cancer Society,1998,83:2638-2648.
[2]田兴松,刘奇.实用甲状腺外科学[M].上海:北京人民军医出版社,2009:75-79.
[3]蒋国梁.临床肿瘤学[M].上海:上海科学技术文献出版社,2004:445-445.
[4]徐东楚,张励.甲状腺乳头状癌临床分析[J].齐齐哈尔医学院学报,2010,31(18):2910-2910.
[5]腾卫平,刘永峰,高明,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[6]潘烨,邹建华,郑起,等.预防性颈中央区淋巴结清除术治疗甲状腺乳头状癌安全性的meta分析[J].中国现代普通外科进展,2010,13(1):24-27.
[7]武鸿彪,付强,朱理玮.甲状腺乳头状癌的手术治疗方式比较[J].中国中西医结合外科杂志,2011,17(2):154-156.
[8]刘永峰.分化型甲状腺癌初始手术规范化思考[J].中国实用外科杂志,2011,31(5):371-373.
[9]李劲东.分化型甲状腺癌甲状腺切除范围[J].医学与哲学,2012,33(11B):11-13.
[10]曾志军,欧迪鹏,杨连粤.全甲状腺切除术手术指针、要点及并发症防治[J].中国实用外科杂志,2010,30(10):867-869.
[11]HAIGH P I,URBACH D R,ROSTEIN L E.Extent of thyroidectomy is not a major determinant of survival in low-or high-risk papillary thyroid cancer[J].Ann Surg Oncol,2005,12:81-89.
[12]DAVIES L,WELCH H G.Thyroid cancer survival in the United States:observational data from 1973to2005[J].Arch Otolaryngol Head Neck Surg,2010,136:440-444.
[13]吴阶平,裘法祖,吴孟超,等.黄家驷外科学[M].7版.北京:人民卫生出版社,2008:1132-1139.
[14]HAIGH P I,URBACH D R,ROTSTEIN L E.Extent of thyroidectomy is not a major determinant of survival in low-or high-risk papillary thyroid cancer[J].Ann Surg Oncol,2005,12:81-89.
[15]VOUTILAINEN P E,SIIRONEN P,FRANSSILA K O,et al.AMES,MACIS,and TNM prognostic classifications in-papillary thyroid carcinoma[J].Anticancer Res,2003,23:4283-4288.
[16]MENDELSOHN A H,ELASHOFF D A,ABEMAYOR E,et al.Surgery for papillary thyroid carcinoma is lobectomy enough[J]?Arch Otolaryngol Head Neck Surg,2010,136:1055-1061.
[17]HUNDAHL S A,FLEMING I D,FREMGEN A M,et al.A National Cancer Data Base report on 53,856cases of thyroid carcinoma treated in the U.S.,1985-1995[see commetns][J].Am Cancer Society,1998,83:2638-2648.