胸腔镜下肺段切除与肺叶切除治疗临床Ⅰ期非小细胞肺癌疗效对比的Meta分析

A Meta-analysis of video-assisted thoracic segmentectomy versus lobectomy for stage Ⅰ non-small cell lung cancer

背景与目的:对于临床Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC),胸腔镜下肺段切除因其对患者损伤更小而越来越受到胸外科医师的重视,但是腔镜下肺叶切除术仍被认为是标准的治疗方式。因此,系统评价胸腔镜下肺段切除与肺叶切除治疗临床Ⅰ期NSCLC的临床疗效,以期为临床决策提供借鉴。方法:计算机检索Pub Med、Web of Science、EMBASE、The Cochrane Library、CNKI、CBM、VIP和万方等数据库,检索时间截至2015年7月,收集胸腔镜下肺段切除与肺叶切除治疗临床Ⅰ期NSCLC的对比研究,由2名研究员分别对纳入的研究进行数据提取和质量评价,最后采用Cochrane协作网提供的Revman 5.3软件进行Meta分析。结果:共纳入11篇回顾性临床对照研究,共计1 677例患者。Meta分析结果显示,对于临床Ⅰ期NSCLC,胸腔镜下肺段切除与肺叶切除术后总体复发率(OR=0.77,95%CI:0.48~1.21,P=0.25)、5年生存率(OR=0.77,95%CI:0.52~1.14,P=0.19)和全身并发症(OR=0.76,95%CI:0.53~1.09,P=0.13)差异均无统计学意义,但胸腔镜下肺段切除可减少术中失血量[均数差(difference in means,MD)=-41.16,95%CI:-59.46^-22.86,P<0.000 1]、缩短术后胸管引流时间(MD=-0.29,95%CI:-0.49^-0.09,P=0.005)和住院时间(MD=-0.74,95%CI:-1.44^-0.05,P=0.04)。结论:对于临床Ⅰ期NSCLC,胸腔镜下肺段切除和肺叶切除在术后总体复发率、全身并发症和5年生存率上效果相当,但是在术中失血量、术后胸管引流时间和住院时间方面胸腔镜下肺段切除效果更好,是一种可供选择的手术方式。

Background and purpose： For stage Ⅰ non-small cell lung cancer （NSCLC）, video-assisted thoracic segmentectomy is given much attention to by thoracic surgeon because of the less tissue damages. However, video-assisted thoracic lobectomy is still considered as the standard treatment in the world. Therefore, this study was to evaluate the clinical effect after video-assisted thoracic segmentectomy and lobectomy in patients with stage Ⅰ NSCLC in order to provide reference for clinical application. Methods： The comparative studies on video-assisted thoracic segmentectomy and lobectomy treating stage I NSCLC were retrieved from PubMed, Web of Science, EMBASE, the Cochrane Library, CNKI, CBM, VIP, and Wanfang Data. All data were acquired until July 2015. Literature screening according to data extraction and quality assessment was completed by two reviewers independently. Meta-analysis was conducted by RevMan 5.3 software which was offered by Cochrane network. Results： A total of 11 articles involving 1 677 patients were finally included. The results of meta-analysis indicated that： for stage Ⅰ NSCLC, compared with video-assisted thoracic lobectomy, the effect of video-assisted thoracic segmentectomy was alike in total mortality （OR=0.77, 95%CI： 0.48 to 1.21, P=0.25）, 5-year mortality （OR=0.77, 95%CI： 0.52 to 1.14, P=0.19） and systemic complications （OR=0.76, 95%CI： 0.53 to 1.09, P=0.13）, but could reduce blood loss [difference in means （MD）=-41.16, 95%CI： -59.46 to -22.86, P〈0.000 1], chest tube duration （MD=-0.29, 95%CI： -0.49 to -0.09, P=0.005） and the length of hospital stay （MD=-0.74, 95%CI： -1.44 to -0.05, P=0.04）. Conclusion： Compared with video-assisted thoracic lobectomy, video-assisted thoracic segmentectomy can significantly reduce blood loss, chest tube duration and length of hospital stay. However, the two kinds of operation methods achieved the same effects on the total mortality, 5-year mortality and systemic complications. Thoracoscopic segmentectomy may be an alternative to thoracic lobectomy.