mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2023-2-9-21mossj-672Research ArticleХИРУРГИЯ ГОЛОВЫ И ШЕИHEAD AND NECK SURGERYСравнение трансаксиллярного эндоскопического и традиционного доступов при операциях на щитовидной железе (систематический обзор и метаанализ)Comparison of transaxillary endoscopic and open approaches in thyroid surgery (systematical review and meta-analysis)https://orcid.org/0000-0002-0903-9329ГлушковП. С.GlushkovP. S.

Павел Сергеевич Глушков, кандидат медицинских наук, врач-хирург

119991

Абрикосовский переулок, д. 2

Москва

Pavel Sergeevich Glushkov, PhD, surgeon

119991

Abrocosovkii pereulok, b. 2

Moscow

paulgl@mail.ruhttps://orcid.org/0000-0001-7081-7911АзимовР. Х.AsimovR. H.

Рустам Хасанович Азимов, кандидат медицинских наук, заведующий отделением, доцент

отделение хирургии

119991

Абрикосовский переулок, д. 2

117198

ул. Миклухо-Маклая, д. 6

Москва

Rustam Khasanovich Azimov, PhD, Head, Associate Professor

Department of Surgery

119991

Abrocosovkii pereulok, b. 2

117198

Miklukho-Maklaya str. 6

Moscow

doc_rustam@rambler.ruhttps://orcid.org/0000-0001-7203-1859ПономаренкоА. А.PonomarenkoA. A.

Алексей Алексеевич Пономаренко, доктор медицинских наук, ведущий научный сотрудник

123423

ул. Саляма Адиля д. 2

Москва

Alexey Alexseevich Ponomarenco, MD, Leading Researcher

123423

Saliama Adylia str. 2

Moscow

dr.ponomarenkoaa@gmail.comhttps://orcid.org/0000-0002-1710-4055ШемятовскийК. А.ShemyatovskyK. A.

Кирилл Александрович Шемятовский, кандидат медицинских наук, врач-хирург

119991

Абрикосовский переулок, д. 2

Москва

Kirill Aleksandrovich Shemyatovsky, Ph. D., surgeon

119991

Abrocosovkii pereulok, 2

Moscow

kiroll@mail.ruhttps://orcid.org/0000-0002-3919-8435ГорскийВ. А.GorskyV. A.

Виктор Александрович Горский, доктор медицинских наук, профессор

119991

117997

ул. Островитянова, д. 1, стр. 7

117198

ул. Миклухо-Маклая, д. 6

Москва

Viktor Aleksandrovich Gorsky, MD, Professor

119991

117997

Ostrovityanova str. 1

117198

Miklukho-Maklaya str. 6

Moscow

gorviks@yandex.ruФГБНУ «Российский научный центр хирургии им. академика Б. В. Петровского, НКЦ № 2»РоссияPetrovsky National Research Centre of Surgery, Scientific and Clinical Center № 2Russian FederationФГБНУ «Российский научный центр хирургии им. академика Б. В. Петровского, НКЦ № 2»; ФГБАУ ВО «Российский университет дружбы народов»РоссияPetrovsky National Research Centre of Surgery, Scientific and Clinical Center № 2; The Peoples' Friendship University of RussiaRussian FederationФГБУ «НМИЦ колопроктологии имени А. Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian FederationФГБНУ «Российский научный центр хирургии им. академика Б. В. Петровского, НКЦ № 2»; ФГБАУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России; ФГБАУ ВО «Российский университет дружбы народов»РоссияPetrovsky National Research Centre of Surgery, Scientific and Clinical Center № 2; Pirogov Russian National Research Medical University; The Peoples' Friendship University of RussiaRussian Federation20231307202302921Copyright © Глушков П.С., Азимов Р.Х., Пономаренко А.А., Шемятовский К.А., Горский В.А., 20232023Глушков П.С., Азимов Р.Х., Пономаренко А.А., Шемятовский К.А., Горский В.А.Glushkov P.S., Asimov R.H., Ponomarenko A.A., Shemyatovsky K.A., Gorsky V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/672   Введение

   Введение. При всех косметических преимуществах малоинвазивного доступа к щитовидной железе (ЩЖ) существует мнение, что эндоскопические операции более травматичны, чем открытые, повышают риски интраоперационных и послеоперационных осложнений. Для уточнения данных о преимуществах эндоскопического доступа над традиционным при операциях на ЩЖ выполнен метаанализ.

   Цель исследования

   Цель исследования. Провести метаанализ результатов операций на ЩЖ трансаксиллярным эндоскопическим (ТАТЭ) и открытым доступами (ОТЭ).

   Материалы и методы исследования. Анализу подверглись 8 ретроспективных, 4 проспективных и 1 рандомизированное сравнительное исследование, включающие результаты лечения 6484 пациентов. Статистическую обработку выполняли в программе Review Manager 5.4. Суммарное значение дихотомических данных описывали с 95 % доверительным интервалом в виде отношения шансов. Статистическую гетерогенность среди включенных в метаанализ исследований оценивали с помощью χ2 теста. При р < 0,1 и I2 >50 % гетерогенность считали статистически значимой.

   Результаты исследования. Проведенный метаанализ подтвердил преимущество ТАТЭ перед ОТЭ в отношении косметических результатов лечения. В отношении объема интраоперационной кровопотери, частоты и структуры послеоперационных осложнений ТАТЭ была сопоставима с ОТЭ. Статистически значимой разницы между ТАТЭ и ОТЭ в выраженности болевого синдрома и длительности пребывания пациентов в стационаре не наблюдалось.

   Заключение

   Заключение. ТАТЭ при доброкачественных и злокачественных новообразованиях ЩЖ являются безопасной альтернативой открытым операциям. ТАТЭ максимально эффективна и безопасна в руках опытного хирурга, прошедшего кривую обучения.

   Introduction

   Introduction. The cosmetic effect of endoscopic thyroidectomy is indisputable. However, there are questions about the appropriateness of such an operation. A meta-analysis was performed to summarize data on the advantages of endoscopic over open access in thyroid surgery.

   Aim of the study

   Aim of the study. To conduct a meta-analysis of the results of operations on the thyroid gland with transaxillary endoscopic (TATE) and open access (OTE).

   Materials and methods

   Materials and methods. 8 retrospective, 4 prospective and 1 randomized comparative study were analyzed, including the results of treatment of 6484 patients. Statistical processing was performed in the Review Manager 5.4 program. The sum of the dichotomous data was reported with a 95 % confidence interval as an odds ratio. Statistical heterogeneity among the studies included in the meta-analysis was assessed using the χ2 test. At p<0,1 and I2>50 % heterogeneity was considered statistically significant.

   Results

   Results. The conducted meta-analysis confirmed the advantage of TATE over OTE in terms of cosmetic results of treatment. With regard to the volume of intraoperative blood loss, the frequency and structure of postoperative complications, TATE was comparable to OTE. There was no statistically significant difference between TATE and OTE in the severity of pain syndrome and the length of stay of patients in the hospital.

   Conclusion

   Conclusion. TATE for benign and malignant neoplasms of the thyroid gland is a safe alternative to open surgery. TATE is most effective and safe when performed by an experienced surgeon who has gone through a learning curve.

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The authors declare that there are no conflicts of interest present.