来源：Surg Endosc 2020 Mar 06;

题目

英文：Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis.

中文：腔镜下甲状腺全切和开放性甲状腺全切的比较，一篇系统回顾与meta分析

研究背景

英文：Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC).

中文：尽管在内径下的甲状腺手术能达到最小的伤口，但对于甲状腺癌手术，内镜下甲状腺全切除术(TET)的作用仍备受争议。该篇研究对已发表的研究进行了系统回顾和meta分析，以评估内镜下甲状腺全切除术与传统开放甲状腺切除术(COT)在治疗甲状腺乳头状癌(PTC)方面的安全性和有效性。

方法

英文：Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis.

中文：对PubMed、Embase、Cochrane Library和Web of science等医学文献数据库进行了系统检索，查找时间为从数据库建立到2019年3月，关于内镜下甲状腺全切除术与传统开放甲状腺切除术(COT)治疗甲状腺乳头状癌(PTC)方面的文章。使用Downs和Black量表对纳入的研究的质量进行评估，使用综述管理软件Stata V.13.0进行meta分析。

结果

英文：The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up.Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction.total endoscopic thyroidectomy was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05).conventional open thyroidectomy was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05).

中文：这篇研究纳入20片文献，共计患者5664例。 判断手术是否完整的标准：包括术后甲状腺球蛋白(TG)水平、长期随访后肿瘤复发情况。不良事件及并发症发生率评分包括暂时性喉返神经麻痹、永久性喉返神经麻痹、暂时性低钙血症、永久性低钙血症、手术时间、淋巴结清扫数、住院时间及患者美容满意度。经内镜下甲状腺全切除术与传统开放性手术比较，在手术的完整性和不良事件发生率方面是相当的没有差别；但经内镜下甲状腺全切除术导致了较低水平的暂时性低钙血症(OR 1.66;P<0.05)，切除的淋巴结数目较少(WMD 0.46;P< 0.05)，美容满意度较好(WMD 1.73; P<0.05)。传统开放甲状腺切除术的手术时间较短(WMD - 50.28;p < 0.05)和暂时性喉返神经麻痹发生率较低(OR 0.41;p < 0.05)。

结论

英文：The results show that in terms of safety and efficacy, total endoscopic thyroidectomy was similar to conventional open thyroidectomy for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in total endoscopic thyroidectomy are similar to those obtained for conventional open thyroidectomy. total endoscopic thyroidectomy was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the total endoscopic thyroidectomy.

中文：结果表明，在安全性和有效性方面，内镜下甲状腺全切术与常规开放甲状腺切除术治疗甲状腺癌相似。事实上，内镜下甲状腺全切除术的肿瘤复发率和手术完成程度与常规开放甲状腺切除术相似。内镜下甲状腺全切除术与短暂性低钙血症和较好的美容满意度相关，因此，内镜下甲状腺全切除术是有美容要求患者的较好的选择。总的来说，需要更大的随机临床试验和研究患者群体和长期随访数据，来进一步证明全腔镜甲状腺切除术的价值。