早期非小细胞肺癌外科治疗的荟萃分析

Whether lobectomy or segmentectomy should be performed for early stage non-small cell lung cancer?A meta-analysis

目的：比较肺段切除与肺叶切除对非小细胞肺癌患者外科治疗的有效性.方法：对PubMed以及Cochrane协作数据库进行全面的搜索,搜索词：肺段切除、肺叶切除、肺癌、对照性研究.应用REV 5.0及Sta-ta12.0进行统计.结果：最终26篇文献入组.组间比较术后肺漏气（RR=1.16,95％CI 0.71～1.89,P=0.55）、肺部感染（RR=1.71,95％CI 0.51～5.73,/P=0.38）、房颤（RR=0.51,95％CI 0.15～1.71,P--0.27）、围手术期30d死亡率无显著性差异（RR=0.84,95％CI 0.67～1.06,P=0.13）的发生率无显著性差异;肺段切除组低氧血症（RR=4.63,95％CI1.41～15.26,P=0.01）的发生率较高.肺段切除组的局部复发率较高（RR=1.36,95％CI 1.01～1.83,P=0.04）;组间比较全身转移率无显著性差异（RR--0.87,95％CI 0.67～1.12,P=0.28）;组间比较无瘤生存期无显著性差异（RR=1.02,95％CI 0.84～1.23,P=0.87）;组间比较总生存率无显著性差异（RR=1.02,95％CI 0.91～1.14,P=0.76）.结论：肺段切除围手术期安全性较高,远期复发率、无瘤生存期及远期生存率与肺叶切除无区别.

Objective：To compare surgical efficacy of lobectomy or segmentectomy on early stage non-small cell lung cancer.nethods：Pubmed and Cochrane database were searched.Meshterms of＇segmentectomy＇,＇lobectomy＇, ＇lung cancer＇, ＇comparative＇were used.REV 5.0 and Statal2.0 were used for analysis.Funnel plot was used to exclude publication bias.Results：Twenty-six articles were included.Postoperative air leakage （RR= 1.16,95%CI 0.71-1.89,P=O.55）,pulmonary infection（RR=l.71,95%CI 0.51-5.73,P=O.38）,atrial arrithmia（RR= 0.51,95%CI 0.15-l.71,P=0.27）and postoperative 30 days＇ mortality （RR=0.84,95%CI 0.67-1.06,P=0.13） showed no difference between the two groups.While postoperative hypoxemia was lower in segmentectomy group（RR=4.63,95%CI 1.41-15.26,P=0.01）.Local recurrence（RR=1.36,95%CI 1.01-1.83,P=0.04）and systemic recurrence（RR=0.87,95%CI 0.67-1.12,P=0.28）showed no difference between the two groups.Disease free survival （RR=1.02,95%CI 0.84-l.23,P=0.87）and overall same in both groups.Conclusion：As no difference were survival （RR=1.02,95%CI 0.91-1.14,P=0.76）were the showed for recurrence, disease free survival and overall survival,we considered that segmentectomy could be used as an alternate of lobectomy for early stage nonsmall cell lung cancer.