纳米碳在腔镜甲状腺癌手术中应用效果的Meta分析

成晓舟 李亚萍 屈坤鹏 张宇鹏 王小虎

【摘要】 目的：探讨纳米碳在甲状腺癌患者手术中的实用性及安全性，并从腔镜甲状腺癌手术中淋巴结清扫和甲状旁腺的保護方面评估其临床应用价值。方法：计算机检索Cochrane图书馆、PubMed、CNKI、Wanfang、VIP和CBM数据库，搜索并比较从建库至2019年10月发表的腔镜甲状腺癌手术中纳米碳和非纳米碳示踪剂的文献。两名研究人员分别审查文献、提取数据，评估纳入研究的偏倚风险，使用RevMan 5.3软件进行统计分析。结果：共纳入5篇文献，348例患者。荟萃分析结果显示，纳米碳组中检测到淋巴结数目多于非纳米碳组[WMD=3.37，95%CI（2.35，4.38），P<0.000 01]、甲状旁腺误切发生率低于非纳米碳组[OR=0.11，95%CI（0.05，0.24），P<0.000 01]。结论：纳米碳在腔镜甲状腺癌手术中的应用能提高淋巴结的检出率，并在一定程度上减少甲状旁腺的损伤，在完成更加彻底清扫淋巴结的同时又可达到保护甲状旁腺的效果。

【关键词】 甲状腺癌 纳米碳 腔镜手术 Meta分析 随机对照试验

[Abstract] Objective： To explore the practicability and safety of nano carbon in thyroid cancer surgery， and evaluate its clinical application value from the aspects of lymph node dissection and parathyroid gland protection in endoscopic thyroid cancer surgery. Method： Computer search Cochrane Library， PubMed， CNKI， Wanfang， VIP and CBM databases were searched and compared for literatures on nano carbon and non-nano carbon in endoscopic thyroid cancer surgery from the establishment of the database until October 2019. Two investigators separately reviewed the literature， extracted the data， assessed the risk of bias in the included studies， and performed statistical analysis using RevMan 5.3 software. Result： A total of 5 articles， 348 patients， were included. The results of meta-analysis showed that the number of lymph nodes detected of nano carbon group were more than those of non-nano carbon group [WMD=3.37， 95%CI （2.35， 4.38）， P<0.000 01]， and the incidence of parathyroid gland misresection were lower than those of non-nano carbon group [OR=0.11， 95%CI （0.05， 0.24）， P<0.000 01]. Conclusion： The application of nano-carbon in endoscopic thyroid cancer surgery could improve the detection rate of lymph nodes and reduce the damage of parathyroid gland to a certain extent， achieve the effect of protecting the parathyroid gland while completing a more thorough dissection of lymph nodes.

[Key words] Thyroid cancer Nano carbon Endoscopic surgery Meta-analysis Randomized controlled trial

First-author’s address： Gansu Provincial Hospital， Lanzhou 730000， China

doi：10.3969/j.issn.1674-4985.2021.17.041

近年来，甲状腺癌已经成为内分泌系统中常见的一种恶性肿瘤，且发病率呈上升趋势[1]。90%以上是甲状腺乳头状癌，即使是微小乳头状癌，其中央区淋巴结约有50%发生转移[2]。目前，治疗甲状腺乳头状癌的首选方法是在患侧进行甲状腺腺叶切除术和同侧中央区淋巴结清扫术，替代了可导致永久性颈部瘢痕的传统手术。对于甲状腺癌患者，不仅需要有效的治疗，而且还需满足人们对美容的心理需求，腔镜甲状腺手术随即产生。目前，伴随着腔镜技术的迅速发展，腔镜甲状腺腺叶切除及中央区淋巴结彻底清扫已安全可行[3]。……