单孔法与多孔法胸腔镜下肺叶切除术治疗非小细胞肺癌疗效的系统评价与Meta分析

Single-versus multiple-port thoracoscopic lobectomy in non-small cell lung cancer: A systematic review and meta-analysis

目的对单孔法与多孔法胸腔镜下肺叶切除术两种术式治疗非小细胞肺癌的有效性及安全性进行系统评价。方法通过计算机检索PubMed、EMbase、The Cochrane Library、CBM、知网、万方、维普以及Web of Science等数据库,检索时间由其建库至2018年8月。筛选文献、提取资料以及评价偏倚风险由两名研究员独立完成,并对所采集数据使用RevMan 5.3软件进行Meta分析。结果本文共纳入11篇研究(4篇随机对照研究,1篇前瞻性队列研究,6篇回顾性队列研究),共计1 574例患者,其中单孔法组779例,多孔法组795例。Meta分析结果显示:两组在手术时间[MD=3.60,95%CI(–8.59,15.79),P=0.56]、术中中转率[OR=1.06,95%CI(0.54,2.06),P=0.87]、术后住院时间[MD=0.74,95%CI(–1.60,0.12),P=0.09]、术后并发症发生率[OR=0.76,95%CI(0.53,1.10),P=0.15]、术后引流时间[MD=0.63,95%CI(–1.28,0.02),P=0.06]、清扫淋巴结数[MD=–0.11,95%CI(–0.46,0.24),P=0.54]方面差异无统计学意义;两组在术中出血量[MD=–17.12,95%CI(–31.16,–3.08),P=0.02]、术后第1 d疼痛评分[MD=–1.30,95%CI(–1.85,–0.75),P<0.000 01]、术后第3 d疼痛评分[MD=–0.82,95%CI(–1.00,–0.65),P<0.000 01]方面差异有统计学意义。结论单孔法与多孔法胸腔镜下肺叶切除术治疗非小细胞肺癌效果相当;在术中出血量、第1 d及第3 d疼痛评分方面,单孔组手术较多孔组手术有一定的优势。

Objective To systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery(VATS) vs. multiple-port VATS in lobectomy for non-small cell lung cancer(NSCLC). Methods The PubMed,EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single-vs. multiple-port VATS for patients with NSCLC from inception to August 2018. The literatures were screened, data were extracted and the risk of bias of included studies was assessed independently by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software. Results Eleven studies(4 randomized controlled trials, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients.Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that there was no significant difference between the two groups in the operation time(MD=3.60, 95%CI –8.59 to15.79, P=0.56), the conversion rate(OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications(OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time(MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time(MD=0.63, 95%CI –1.28 to 0.02, P=0.06) or harvested lymph nodes(MD=–0.11, 95%CI –0.46 to0.24, P=0.54). The intraoperative blood loss(MD=–17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than that in the multiple-port group. The visual analogue score(VAS) on postoperative first day(MD=–1.30,95%CI –1.85 to –0.75, P<0.000 01) and on postoperative third day(MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group. Conclusion The meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent to multiple-port VATS. However the intraoperative blood loss, the VAS scores on postoperative first and third days in the single-port group are better.