胸腔镜手术与开胸手术治疗肺隔离症临床效果与安全性的荟萃分析

Video-assisted thoracoscopic surgery versus open thoracotomy for pulmonary sequestration:a meta-analysis of efficacy and safety

目的评价胸腔镜手术与开胸手术治疗肺隔离症的临床效果和安全性。方法计算机检索PubMed、Web of Science、Cochrane Library、中国知网、万方等数据库中比较胸腔镜手术与开胸手术治疗肺隔离症的相关文献。检索时间均为建库至2021年5月30日。由两名评价者按照纳入与排除标准独立筛选文献、提取资料、评价文献质量,采用RevMan5.4软件进行荟萃分析。结果最终纳入14篇文献,均为回顾性队列研究,共594例患者,其中胸腔镜组261例,开胸组333例。荟萃分析结果显示:与开胸手术相比,胸腔镜手术时间显缩短(MD=–9.48,95%CI:–18.63~–0.33,P=0.04)、术中出血量明显减少(MD=–60.88,95%CI:–113.64~–8.12,P=0.02)、术后胸管留置时间明显缩短(MD=–1.58,95%CI:–2.60~–0.56,P=0.02)、术后并发症明显减少(OR=0.54,95%CI:0.32~0.92,P=0.02)、术后住院时间明显降低(MD=–2.13,95%CI:–3.50~–0.77,P=0.002)。两组在术后胸腔引流量方面差异无统计学意义(MD=–67.61,95%CI:–247.93~112.71,P=0.46)。结论胸腔镜手术治疗肺隔离症安全可行,具有手术时间短、术中出血量少、术后胸管留置时间短、并发症少、住院时间短等优势。

Objective To evaluate the efficacy and safety of video-assisted thoracoscopic surgery(VATS)versus open thoracotomy(OT)for pulmonary sequestration.Methods We searched the electronic databases including PubMed,Web of Science,Cochrane Library,CNKI,and Wanfang Data for relevant studies published from the establishment of the databases to May 30,2021.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted data,and evaluated the quality of the literature.A meta-analysis was performed using RevMan 5.4 software.Results A total of 14 retrospective cohort studies enrolling 594 patients were included,with 261 in the VATS group and 333 in the OT group.The results of meta-analysis showed that the VATS group had shorter operative time(MD=–9.48,95%CI:–18.63 to–0.33,P=0.04),less intraoperative blood loss(MD=–60.88,95%CI:–113.64 to–8.12,P=0.02),shorter chest drainage time(MD=–1.58,95%CI:–2.60 to–0.56,P=0.02),lower postoperative complication rate(OR=0.54,95%CI:0.32–0.92,P=0.02),and shorter postoperative hospital stay(MD=–2.13,95%CI:–3.50 to–0.77,P=0.002).There were no significant differences in the postoperative drainage volume(MD=–67.61,95%CI:–247.93 to 112.71,P=0.46).Conclusion VATS is a safe and feasible surgical approach in the treatment of pulmonary sequestration with advantages including shorter operative time,less intraoperative blood loss,shorter chest drainage time,lower postoperative complication rate,and shorter postoperative hospital stay.