局部浸润麻醉（前野阻滞）与全身麻醉用于甲状腺切除术：对手术时间、并发症和费用的影响——一项采用GRADE评级的系统评价和荟萃分析及亚组分析。
完整摘要 · 中文译文
引言：甲状腺切除术涉及切除部分或全部甲状腺，通常用于甲状腺肿、甲状腺功能亢进或癌，在美国每年实施450,000-500,000例手术。传统上使用全身麻醉，可提供最佳手术条件，但与心血管并发症和住院时间延长等风险相关。局部麻醉在高危患者中正受到关注，可能提供与全身麻醉相似的结果，同时减少术后并发症和费用。麻醉技术的选择影响患者安全、医疗费用和整体体验，但此前尚无meta分析比较甲状腺切除术中局部麻醉与全身麻醉。 目的：本系统综述和meta分析旨在比较甲状腺切除术中全身麻醉与局部麻醉的手术和围手术期结局，重点关注手术时间、并发症、费用和术后恢复，以指导临床实践。 方法：本综述按照系统综述和meta分析首选报告项目指南进行。对PubMed/MEDLINE、Embase、Web of Science和Scopus进行了从数据库建库至2025年8月的系统检索。我们纳入了比较甲状腺切除术患者局部浸润麻醉与全身麻醉的随机对照试验、队列研究和病例对照研究。关键结局包括手术时间、术中及术后并发症、住院时间、疼痛评分、患者满意 结局、以及成本。数据由两位作者独立提取。采用Cochrane偏倚风险2（RoB 2）工具评估随机试验的偏倚风险，采用非随机干预研究偏倚风险工具评估非随机研究的偏倚风险。采用推荐分级的评估、制定与评价框架评价证据确定性。使用Review Manager（RevMan）进行统计分析，在随机效应模型下计算均数差和风险比，并使用I²统计量评估异质性。统计显著性设定为p < 0.05。 结果：系统检索共识别出1，785项研究，其中剔除252项重复文献。经过筛选，排除1，508项研究，进而对25项研究进行全文审查，最终纳入5项研究，共涉及508例接受局部麻醉或全身麻醉甲状腺手术的患者。与全身麻醉相比，局部麻醉与更短的手术时间相关（均数差-18.32 min，95% CI：-27.31至-9.15），但异质性较高（I² = 95%），且该效应仅在队列研究中显著，在随机试验中不显著，因此，该发现应谨慎解读。两组在神经损伤或呼吸窘迫方面未观察到显著差异，尽管这些结局的证据确定性较低。成本分析提示，在所有报告成本数据的研究中，局部麻醉均较全身麻醉费用更低。两组患者满意度似乎均较高 在评估该因素的研究中各组之间。 结论：在甲状腺切除术中，与全身麻醉相比，局部麻醉与更短的手术时间、更低的费用和更短的住院时间相关。然而，这些发现来源于少量研究，因此应谨慎解读。对于需要气道控制和患者完全制动的更复杂手术，全身麻醉可能仍然是必要的。
完整摘要 · 英文原文
INTRODUCTION: Thyroidectomy involves the removal of part or all of the thyroid gland, commonly performed for goiters, hyperthyroidism, or carcinomas, with 450,000-500,000 procedures performed annually in the United States. General anesthesia is traditionally used, providing optimal surgical conditions but associated with risks such as cardiovascular complications and longer hospital stays. Local anesthesia is gaining interest for high-risk patients, offering potentially similar outcomes to general anesthesia, while reducing postoperative complications and costs. The choice of anesthetic technique impacts patient safety, healthcare costs, and overall experience, yet no meta-analysis has previously compared local and general anesthesia for thyroidectomy. AIM: This systematic review and meta-analysis aimed to compare surgical and perioperative outcomes of general anesthesia vs. local anesthesia in thyroidectomy, focusing on operative time, complications, cost, and postoperative recovery, to inform clinical practice. METHODS: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of PubMed/MEDLINE, Embase, Web of Science, and Scopus was performed from database inception to August 2025. We included randomized controlled trials, cohort studies, and case-control studies comparing local infiltration anesthesia with general anesthesia in patients with thyroidectomy. Key outcomes included operative time, intraoperative and postoperative complications, hospital stay length, pain scores, patient satisfaction, and cost. Data were extracted independently by two authors. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials and the Risk of Bias In Non-Randomized Studies of Interventions tool for non-randomized studies. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation framework. Statistical analysis was performed using Review Manager (RevMan), calculating mean differences and risk ratios under a random-effects model, with heterogeneity assessed using the I 2 statistic. Statistical significance was set at p < 0.05. RESULTS: The systematic search identified 1,785 studies, of which 252 duplicates were removed. After screening, 1,508 studies were excluded, leading to a full-text review of 25 studies and ultimate inclusion of 5 studies comprising 508 patients undergoing thyroid surgery with either local or general anesthesia. Local anesthesia was associated with a shorter operative time than general anesthesia (mean difference -18.32 min, 95% CI: -27.31 to -9.15), but heterogeneity was high (I 2 = 95%), and the effect was significant only in cohort studies and not in randomized trials, and therefore, this finding should be interpreted with caution. No significant differences were observed between groups in nerve injury or respiratory distress, although evidence certainty for these outcomes was low. A cost analysis suggested that local anesthesia was less expensive than general anesthesia across all studies reporting cost data. Patient satisfaction appeared comparably high in both groups across the studies that assessed this factor. CONCLUSION: Local anesthesia was associated with shorter operative times, lower costs, and shorter hospital stays compared with general anesthesia in thyroidectomy. However, these findings are drawn from a small number of studies and therefore should be interpreted cautiously. General anesthesia also likely remains necessary for more advanced procedures requiring airway control and complete patient immobility.