Total Throidectomy Versus Bilateral Subtotal Throidectomy For The Treatment Of Multinodular Goiter

Objective: To evaluate the effectiveness and safety of TotalThyroidectomy (TT) combined with Bilateral Subtotal Thyroidectomy(BST) for the treatment multinodular goiter(MNG).Methods: The databases such asPUBMED, EMBASE, The CochraneLibrary, CNKI and WanFang data were searched to collect clinicalcontrolled trials from the date of their establishment to April2012, theliterature limit in Chinese and English, and the relevant references of theincluded studies were also retrieved. Involving the references which werethe clinical controlled studies of TT combined with BST for treatmentof multinodular goiter. Using the recommended standard assessmentmethods of "Cochrane System Evaluation Handbook5.0.1” to involveand evaluate the reference. The Meta-analyses were conducted by usingRevMan5.1software. Different heterogeneity of the references hasdifferent analysis mode. We used descriptive analysis to analyze thereferences which heterogeneity is too obvious and which can not be combined.Result: A total of11studies involving701participants were includewhich included3RCT,4cohort studied and4case control study. Theresult showed that：①The incidence rate of temporary recurrent laryngealnerve injury of TT group was significantly higher than the BST group(P <0.00001), OR=2.23,95%CI (1.62,3.07)；②9of the involved refer-ences have an obvious heterogeneity which use descriptive analysis.Theincidencerate of postoperative transient parathyroid dysfunction of the TTand BST was23.37%and17.53%；③t heincidence rate of postoperativepermanent parathyroid insufficiency of TT group was higher than BSTgroup (P=0.006)，OR=1.50，95%CI (1.12,2.00);④The recurrencerate ofTT group was significantly lower than the BST group（P<0.00001）OR=0.02,95%CI (0.01,0.05);⑤There was no statistically differencebetween two groups in permanent postoperative recurrent laryngeal nerveinjury and postoperative bleeding.Conclusion: The recurrence rate of TT group was lower than BSTgroup. While the incidence rate of postoperative transient recurrent lary-ngeal nerve injury，transient and permanent parathyroid dysfunctionwas significantly higher than BST group. The quality of involvedreference was generally low so that we can not make a conclusion to saywhich surgery method is better to treat MNG. The more ideal choose isthat we choose an appropriate treatment to treat different patientsaccording their critical preoperative assessments. However， thisconclusion has to be further verified by high quality,large scale anddouble blinded RCTS.