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目的:系统评价粗针穿刺(CNB)与细针穿刺(FNAB)在诊断甲状腺结节中的准确性和安全性。方法:计算机检索中国知网(CNKI)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library、EMBASE、Web of Science数据库(截止日期2017年2月),检索有关CNB与FNAB比较的文献,2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入文献质量,采用RevMan 5.3软件进行Meta分析。结果:共纳入研究19篇;有关诊断准确性比较文献18篇,其中CNB组2 600例,FNAB组2 777例,Meta分析显示CNB组对比FNAB组诊断准确率差异有统计学意义(RR=1.14,95%CI:1.06~1.22,P<0.01);术后发生血肿情况共纳入文献2篇,其中CNB组3 050例,FNAB组3 497例,二者差异无统计学意义(RR=0.92,95%CI:0.67~1.25,P>0.05)。结论:在熟练掌握穿刺技术情况下,临床中CNB在甲状腺结节诊断中安全可行。
Objective: To systematically evaluate the accuracy and safety of CNB and FNAB in the diagnosis of thyroid nodules. Methods: CNKI, Wanfang database, CBM, PubMed, Cochrane Library, EMBASE, Web of Science database (deadline February 2017) were searched by computer, and CNB was searched for comparison with FNAB Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included articles. Meta-analysis was performed using RevMan 5.3 software. Results: A total of 19 studies were included in this study. There were 18 literatures about diagnostic accuracy, including 2 600 cases in CNB group and 2 777 cases in FNAB group. Meta-analysis showed that there was significant difference in diagnostic accuracy between CNB group and FNAB group (RR = 1.14 , 95% CI: 1.06-1.22, P <0.01). There were 2 articles about the hematoma after operation, including 3 050 cases in CNB group and 3 497 cases in FNAB group. There was no significant difference between the two groups (RR = 0.92, 95% CI: 0.67 ~ 1.25, P> 0.05). Conclusion: CNB is safe and feasible in the diagnosis of thyroid nodules under the condition of mastering the puncture technique.