胸腔镜下右胸入路与剑突下入路胸腺扩大切除术治疗重症肌无力疗效比较的Meta分析

Meta-analysis of efficacy of subxiphoid multiple-port video-assisted thoracoscopic thymectomy versus intercostals multiple-port video-assisted thoracoscopic thymectomy in treating myasthenia gravis

目的采用Meta分析的方法比较胸腔镜经右胸入路与剑突下入路多孔胸腺扩大切除术治疗重症肌无力的疗效、安全性及并发症。方法检索CNKI、PubMed、VIP、万方数据库、迈特思创数据库2010年1月—2020年10月有关胸腔镜右胸入路及剑突下入路多孔胸腺扩大切除术治疗重症肌无力的相关文献,采用Review Manager5.2软件对比两种手术方式的手术时间、术后胸腔引流时间、术后住院时间、术后疼痛评分、术后膈神经麻痹率、术后心律失常发生率、术后重症肌无力缓解率。结果纳入文献8篇,病例数857例,其中胸腔镜经右胸多孔胸腺扩大切除术(multiple-port video-assisted surgery,MVATS)492例(经右胸MVATS),胸腔镜经剑突下多孔胸腺扩大切除术365例(经剑突下MVATS)。Meta分析结果示:经剑突下MVATS与经右胸MVATS相比,在术后重症肌无力缓解率、术后胸腔引流时间、术后膈神经麻痹率、术后心律失常发生率方面无统计学差异(P>0.05);经剑突下MVATS在手术时间、术后住院时间、术后疼痛评分方面均小于经右胸MVATS(P<0.05)。结论经剑突下MVATS与经右胸MVATS治疗重症肌无力的效果相同,但经剑突下MVATS可缩短手术时间、术后住院时间,减轻术后疼痛,更有利于患者术后恢复。

Objective Meta analysis was used to analyze the efficacy,safety and complications of subxiphoid multiple-port video-assisted thoracoscopic thymectomy versus intercostals multiple-port video-assisted thoracoscopic thymectomy in treating myasthenia gravis.Methods Retrieval of literature related to subxiphoid multiple-port video-assisted thoracoscopic thymectomy and intercostals multiple-port video-assisted thoracoscopic thymectomy in treating myasthenia gravis from January 2010 to October 2020 in CNKI,PubMed,VIP,Wanfang database and METSTR Database.Review Manager5.2 software was used to compare the operative time,postoperative thoracic drainage time,postoperative hospital stay,postoperative pain score,postoperative phrenic nerve paralysis rate,postoperative arrhythmia incidence and postoperative myasthenia gravis remission rate.Results Eight references were included and the number of cases was 857.intercostals multiple-port video-assisted thoracoscopic thymectomy was performed in 492 cases.subxiphoid multiple-port video-assisted thoracoscopic thymectomy was performed in 365 cases.The results of Meta analysis showed:subxiphoid multiple-port video-assisted thoracoscopic thymectomy is compared to intercostals multiple-port video-assisted thoracoscopic thymectomy,there were no statistically significant differences in postoperative myasthenia gravis remission rate,postoperative thoracic drainage time,postoperative phrenic nerve paralysis rate and postoperative arrhythmia incidence;the subxiphoid MVATS group was lower than the right intercostal MVATS group in terms of operation time,postoperative hospital stay and postoperative pain score.Conclusion The subxiphoid MVATS group has the same therapeutic effect as the right intercostal MVATS group,but the subxiphoid MVATS group can shorten the operation time and postoperative hospital stay,alleviate postoperative pain and is more conducive to patients'postoperative recovery.