完全电视胸腔镜手术与胸腔镜辅助小切口手术治疗早期非小细胞肺癌临床疗效的Meta分析

Video-assisted Thoracoscope versus Video-assisted Mini-thoracotomy for Non-small Cell Lung Cancer:A Meta-analysis

背景与目的目前未见对全电视胸腔镜手术与胸腔镜辅助小切口手术治疗非小细胞肺癌临床疗效和安全性的系统评价。在本meta分析中,我们比较两组手术治疗非小细胞肺癌的临床效果。方法系统地检索7个主要的医学期刊数据库:PubMed、Embase、CNKI、VIP、ISI Web of Science、the Cochrane Library和CBM,收集时间涵盖2006年5月-2016年5月的有关完全电视胸腔镜手术与胸腔镜辅助小切口手术治疗非小细胞肺癌的随机对照研究(randomized controlled trials,RCT)。由两名研究者对文献质量独立进行评价并提取相关数据,采用Rev Man 5.3软件进行meta分析。结果共纳入13篇RCT,共1,605例患者。其中完全电视胸腔镜组(video-assisted thoracoscopic surgery,VATS)815例,胸腔镜辅助小切口组(video-assisted mini-thoracotomy,VAMT)790例。Meta分析结果显示:全胸腔镜手术与胸腔镜辅助小切口手术治疗非小细胞肺癌相比,手术时间(SMD=13.56,95%CI:4.96-22.16)、术中出血量(SMD=-33.68,95%CI:-45.70--21.66)、胸腔引流管留置时间(SMD=-1.05,95%CI:-1.48--0.62)、胸腔引流量(SMD=-83.69,95%CI:-143.33--24.05)、术后疼痛程度(SMD=-1.68,95%CI:-1.98--1.38)、术后住院时间(SMD=-2.27,95%CI:-3.23--1.31)、两组淋巴结清扫数目(SMD=-0.48,95%CI:-0.80--0.17)等方面的差异有统计学意义;而两组术中的并发症发生率(SMD=0.83,95%CI:0.54-1.29)、手术死亡率(SMD=0.95,95%CI:0.55-1.63)和1年复发率(RR=0.87,95%CI:0.34-2.24)差异无统计学意义(P>0.05)。结论完全电视胸腔镜手术与胸腔镜辅助小切口切除术相比,治疗非小细胞肺癌的并发症发生率和手术死亡率相当,但二者在淋巴结清扫数目、手术时间、术中出血量、胸腔引流量、胸腔引流管留置时间、术后疼痛程度和术后住院时间等方面有差异。现有的临床资料显示:相比胸腔镜辅助小切口手术,全胸腔镜手术是治疗早期非小细胞肺癌更好的选择。

Background and objective The aim of this study is to assess the effect of video-assisted thoracoscopic surgery （VATS） and video-assisted mini-thoracotomy （VAMT） in the treatment of non-small cell lung cancer （NSCLC）. Methods We searched PubMed, EMbase, CNKI, VIP and ISI Web of Science to collect randomized controlled trials （RCTs） of VATS versus VAMT for NSCLC. Each database was searched from May 2006 to May 2016. Two reviewers independently assessed the quality of the included studies and extracted relevant data, using gerMan S.3 rneta-analysis software. Results We finally identified 13 KCTs involving 1,60S patients. There were 815 patients in the VATS group and 790 patients in the VAMT group. The results ofmeta-analysis were as follows： statistically significant difference was found in the harvested lymph nodes （SMD=-0.48, 95%CI： -0.80--0.17）, operating time （SMD=13.56, 95%CI： 4.96-22.16）, operation bleeding volume （SMD=-33.68, 9S%CI： -45.70--21.66）, chest tube placement time （SMD=-I.05, 95%CI： -1.48--0.62）, chest tube drainage flow （SMD=-83.69, 95%CI： -143.33--24.05）, postoperative pain scores （SMD=-1.68, 95%CI： -1.98--1.38） and postoperative hospital stay （SMD=-2.27, 95%CI： -3.23-1.31）. No statistically significant difference was found in postoperative complica- tions （SMD=0.83, 95%CI： 0.54-1.29） and postoperative mortality （SMD=0.95, 95%CI： 0.55-1.63） between videoassisted thoracoscopic surgery lobectomy and video-assisted mini-thoracotomy lobectomy in the treatment of NSCLC. Conclusion Compared with video-assisted mini-thoracotomy lobectomy in the treatment of non-small cell lung cancer, the amount of postoperative complications and postoperative mortality were almost the same in video-assisted thoracoscopic lobectomy, but the amount of harvested lymph nodes, operating time, blood loss, chest tube drainage flow, and postoperative hospital stay were different. VATS is safe and effective in the treatment of NSCLC.