甲状腺癌手术中喉返神经削除与切除术的比较：系统评价与荟萃分析

文献信息

中文摘要

背景： 甲状腺癌侵犯喉返神经（RLN）时，选择削除肿瘤还是切除神经仍存在争议。我们比较了这两种技术的肿瘤学和功能结局。
方法： 遵循PRISMA指南，三名评价者检索了七个数据库，纳入1995年至2024年间比较RLN削除与切除术的研究。探讨的结局包括总生存期、复发、声带功能保留、最长发声时间以及所提供的其他治疗相关并发症。
结果： 共有13项回顾性队列研究（532例患者）符合纳入标准。两组之间的总生存期和气管切开需求无差异。削除与较低的复发率（p = 0.007）、更好的声带活动度（p < 0.0001）和更长的最长发声时间（p = 0.04）相关。
结论： 本分析显示，与切除术相比，削除与更好的功能结局和更低的复发率相关，且无生存差异。由于接受削除的患者疾病分期更早，这些关联可能反映了选择偏倚；需要前瞻性研究。

英文摘要

BACKGROUND: Management of recurrent laryngeal nerve (RLN) invasion by thyroid cancer remains controversial between shaving the tumor and resecting it. We compared oncological and functional outcomes of the two techniques.
METHODS: Following PRISMA guidelines, three reviewers searched seven databases for studies from 1995 to 2024 comparing shaving and resection of the RLN. Outcomes explored were overall survival, recurrence, preservation of vocal cord function, maximum phonation time, and other treatment-related morbidities if provided.
RESULTS: A total of 13 retrospective cohorts (532 patients) met inclusion criteria. Overall survival and tracheotomy requirements did not differ between groups. Shaving was associated with lower recurrence (p = 0.007), better vocal fold mobility (p < 0.0001), and longer maximum phonation time (p = 0.04).
CONCLUSION: This analysis showed that shaving was associated with better functional outcomes and lower recurrence than resection, without a survival difference. Because shaved patients had less advanced disease, these associations may reflect selection bias; prospective studies are needed.