CT引导下Hook-wire定位与弹簧圈定位在肺结节手术中应用的系统评价与Meta分析

CT-guided Hook-wire versus microcoil localization in the pulmonary nodules surgery:A systematic review and meta-analysis

目的系统评价CT引导下Hook-wire定位与弹簧圈定位在肺结节术前定位中的应用效果。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、万方数据库、维普数据库和中国知网数据库,检索建库至2021年10月公开发表的比较CT引导下Hook-wire定位与弹簧圈定位在肺结节定位中应用效果的相关文献,采用Review Manager 5.4软件对文献进行Meta分析,采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对文献进行质量评价。结果共纳入10篇回顾性队列研究,共计1117例患者,其中CT引导下Hookwire定位组473例患者,CT引导下弹簧圈定位组644例患者。纳入文献NOS评分均>6分,质量较高。Meta分析结果显示,Hook-wire定位组与弹簧圈定位组定位操作时间差异无统计学意义[MD=0.14,95%CI(-3.43,3.71),P=0.940]。Hook-wire定位组定位成功率优于弹簧圈定位组,差异有统计学意义[OR=0.35,95%CI(0.17,0.72),P=0.005]。弹簧圈定位组相比于Hook-wire定位组可以降低脱位率[OR=4.33,95%CI(2.07,9.08),P<0.001]、气胸发生率[OR=1.62,95%CI(1.12,2.33),P=0.010]和肺出血发生率[OR=1.64,95%CI(1.07,2.51),P=0.020]。结论虽然Hook-wire定位在肺结节定位成功率方面略优于弹簧圈定位,但是弹簧圈定位在控制脱位、气胸和肺出血发生率方面较Hook-wire定位具有明显优势。因此,从综合方面考虑,本研究认为CT引导下弹簧圈定位是一种值得进一步推广的肺结节术前定位方式。

Objective To systematically evaluate the application effect of CT-guided Hook-wire localization and CT-guided microcoil localization in pulmonary nodules surgery.Methods The literatures on the comparison between CT-guided Hook-wire localization and CT-guided microcoil localization for pulmonary nodules were searched in PubMed,EMbase,The Cochrane Library,Web of Science,Wanfang,VIP and CNKI databases from the inception to October 2021.Review Manager(version 5.4)software was used for meta-analysis.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of studies.Results A total of 10 retrospective cohort studies were included,with 1117 patients including 473 patients in the CT-guided Hook-wire localization group and 644 patients in the CT-guided microcoil localization group.The quality of the studies was high with NOS scores>6 points.The result of meta-analysis showed that the difference in the localization operation time(MD=0.14,95%CI−3.43 to 3.71,P=0.940)between the two groups was not statistically significant.However,the localization success rate of the Hook-wire group was superior to the microcoil group(OR=0.35,95%CI 0.17 to 0.72,P=0.005).In addition,in comparison with Hook-wire localization,the microcoil localization could reduce the dislocation rate(OR=4.33,95%CI 2.07 to 9.08,P<0.001),the incidence of pneumothorax(OR=1.62,95%CI 1.12 to 2.33,P=0.010)and pulmonary hemorrhage(OR=1.64,95%CI 1.07 to 2.51,P=0.020).Conclusion Although Hook-wire localization is slightly better than microcoil localization in the aspect of the success rate of pulmonary nodule localization,microcoil localization has an obvious advantage compared with Hook-wire localization in terms of controlling the incidence of dislocation,pneumothorax and pulmonary hemorrhage.Therefore,from a comprehensive perspective,this study believes that CT-guided microcoil localization is a preoperative localization method worthy of further promotion.