单孔胸腔镜肺大泡切除术治疗自发性气胸患者疗效的Meta分析

Meta-analysis of the Efficacy of Single-port tThoracoscopic Bullaectomy for Spontaneous Pneumothorax

目的 使用Meta分析评价单孔胸腔镜与传统胸腔镜肺大泡切除术对自发性气胸患者的疗效。方法 通过计算机检索中国知网(CNKI)、PubMed、维普科技期刊数据库(VIP)和万方医学网等数据库,检索时间为2018年1月至2022年5月,纳入单孔胸腔镜肺大泡切除术对自发性气胸患者疗效的临床随机对照试验。对所有文献进行筛选、资料提取并依据Cochrane系统进行质量评价,使用RevMan5.4软件、Stata15.0软件进行Meta分析。结果 共纳入14篇文献,共计1 199例患者,研究结果显示:与传统胸腔镜术式相比,单孔胸腔镜能更有效缩短住院时间(WMD=-1.78,95%CI:-2.28~-1.29,P<0.00001)及手术时间(WMD=-4.65,95%CI:-7.11~-2.20,P=0.0002),减少术中出血量(WMD=-6.42,95%CI:-8.30~-4.53,P<0.00001)和术后引流量(WMD=-25.81,95%CI:-40.20~-11.42,P=0.0004),缩短置管时间(WMD=-1.38,95%CI:-2.01~-0.75,P<0.0001),降低术后24 h疼痛(WMD=-1.37,95%CI:-1.65~-1.09,P<0.00001)及术后72 h疼痛(WMD=-1.01,95%CI:-1.12~-0.89,P<0.00001)。纳入14篇文献中,5篇提到了术后并发症,单孔胸腔镜术式发生切口感染2例、肺部感染5例;传统胸腔镜术式发生切口感染7例、肺部感染9例、肺不张3例,差异无统计学意义。结论 相比于传统胸腔镜,单孔胸腔镜术式能更有效地减少术中出血量及术后引流量,缩短住院时间、手术时间及置管时间,降低患者术后疼痛,其临床疗效得到了证实,在临床上应用价值高,但两者发生术后并发症的风险相当。

Objective To evaluate the efficacy of single-port thoracoscopic versus traditional thoracoscopic bullae resection in patients with spontaneous pneumothorax by meta-analysis.Methods A computer search was conducted on CNKI,PubMed,VIP,wanfang Medical Network and other databases from January 2018 to May 2022.Randomized controlled clinical trials on the efficacy of single-port thoracoscopic bullaectomy in patients with spontaneous pneumothorax were included.All literatures were screened and extracted,and quality evaluation was carried out according to the Cochrane system.Meta-analysis was performed using RevMan5.4 software and Stata15.0 software.Results A total of 1 199 patients were included in 14 literatures.The results showed that compared with traditional thoracoscopic surgery,single-port thoracoscopic surgery was more effective in reducing the length of hospital stay(WMD=-1.78,95%CI:-2.28 to-1.29,P<0.00001) and operation time(WMD=-4.65,95%CI:-7.11 to-2.20,P=0.0002),reduced intraoperative blood loss(WMD=-6.42,95%CI:-8.30 to-4.53,P<0.00001) and postoperative drainage volume(WMD=-25.81,95%CI:-40.20 to-11.42,P=0.0004),shorten the catheterization time(WMD=-1.38,95%CI:-2.01 to-0.75,P<0.0001),and reduce the postoperative pain 24 h(WMD=-1.37,95%CI:-1.65 to-1.09,P<0.00001) and 72 h postoperative pain(WMD=-1.01,95%CI:-1.12 to-0.89,P<0.00001).Among the 14 articles included,5 mentioned postoperative complications,including incision infection 2 cases and pulmonary infection 5 cases during single-port thoracoscopic surgery.Incision infection 7 cases,pulmonary infection 9 cases and atelectasis 3 cases occurred in traditional thoracoscopic operation,and the difference was not statistically significant.Conclusion Compared with traditional thoracoscopy,single-port thoracoscopy can more effectively reduce intraoperative blood loss and postoperative drainage,shorten the length of hospital stay,operation time and catheterization time,and reduce postoperative pain.Its clinical efficacy has been verified,and its clinical application value is high,but the risk of postoperative complications is similar between the two.