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经口腔前庭入路内镜甲状腺切除术与开放甲状腺切除术治疗Graves病的比较：系统评价与荟萃分析

Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Open Thyroidectomy for Graves' Disease: A Systematic Review and Meta-Analysis.

综述 Meta咽喉科IF 1.3Q3

文献信息

PMID42914575
原文在 PubMed 查看原文 ↗
发表日期2026
作者Maria Eduarda Caetano Batista de Paiva
查看其他 7 位作者

Thaís Henriques Abud；Mateus Lima Ulisses Trindade；Lucas Monteiro Delgado；Thiago Celestino Chulam；Claudia Theis；Cristina Bellotti Formiga Bueno；Bernardo Fontel Pompeu

作者单位Department of Surgery, Heliopolis Hospital, São Paulo, Brazil.
查看其他 6 条单位信息

Federal University of Minas Gerais, Belo Horizonte, Brazil.；Department of Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil.；Department of Surgery, Federal University of Espirito Santo, Espirito Santo, Brazil.；Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.；Department of Endocrinology, Faculdade de Ciências Médicas Santa Casa Misericórdia de São Paulo, São Caetano do Sul, Brazil.；USCS-University of São Caetano do Sul, São Paulo, Brazil.

期刊Journal of laparoendoscopic & advanced surgical techniques. Part A
SCI 分区Q3
IF1.3
研究类型综述 Meta · 临床
所属专科咽喉科

中文摘要

背景： 经口腔前庭入路内镜甲状腺切除术（TOETVA）已成为传统开放甲状腺切除术（OT）的一种无瘢痕、微创的替代方案。尽管TOETVA在甲状腺手术中已显示出可接受的安全性结局，但由于甲状腺血供丰富所带来的技术复杂性，其在Graves病中的作用仍不确定。
方法： 对PubMed、Scopus、Web of Science和Cochrane对照试验中心注册库进行了系统检索，检索截至2026年5月。纳入评估TOETVA与OT在成人Graves病患者中比较的对照研究。计算合并比值比（ORs）和均数差（MDs）及其95%置信区间（CIs）。采用I2统计量评估异质性。使用ROBINS-I和GRADE评估偏倚风险和证据确定性。
结果： 分析了3项回顾性对照研究，共纳入357例Graves病患者；141例接受TOETVA，216例接受开放甲状腺切除术（OT）。TOETVA与显著更长的手术时间相关（MD +44.4分钟；95% CI：22.7-66.2；P < .01；I2 = 70.4%）。在喉返神经功能障碍、甲状旁腺功能障碍、血肿或手术部位感染方面未观察到显著差异。TOETVA后颏神经损伤（2.13%）和转为开放手术（0.71%）不常见。敏感性分析证实了手术时间结果的稳健性。
结论： 对于Graves病，TOETVA似乎是OT的一种安全且可行的替代方案，术后并发症发生率相当，但手术时间更长。需要进一步的前瞻性多中心研究来证实这些发现。

英文摘要

BACKGROUND: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a scarless, minimally invasive alternative to conventional open thyroidectomy (OT). Although TOETVA has shown acceptable safety outcomes in thyroid surgery, its role in Graves' disease remains uncertain because of the technical complexity associated with hypervascular thyroid glands.
METHODS: A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials through May 2026. Comparative studies evaluating TOETVA versus OT in adults with Graves' disease were included. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I2 statistic. Risk of bias and certainty of evidence were evaluated using ROBINS-I and GRADE.
RESULTS: Three retrospective comparative studies including 357 patients with Graves' disease were analyzed; 141 underwent TOETVA, and 216 underwent open thyroidectomy (OT). TOETVA was associated with significantly longer operative time (MD +44.4 minutes; 95% CI: 22.7-66.2; P < .01; I2 = 70.4%). No significant differences were observed regarding recurrent laryngeal nerve dysfunction, parathyroid dysfunction, hematoma, or surgical site infection. Mental nerve injury (2.13%) and conversion to open surgery (0.71%) were uncommon after TOETVA. Sensitivity analyses confirmed the robustness of operative time findings.
CONCLUSION: TOETVA appears to be a safe and feasible alternative to OT for Graves' disease, with comparable postoperative complication rates but longer operative times. Further prospective multicenter studies are needed to confirm these findings.