吲哚菁绿荧光法与改良膨胀萎陷法应用于胸腔镜肺段切除术的系统评价与Meta分析

Indocyanine green fluorescence versus modified inflation-deflation method in thoracoscopic anatomic segmentectomy:A systematic review and meta-analysis

目的比较吲哚菁绿荧光法与改良膨胀萎陷法应用于胸腔镜解剖性肺段切除术的围手术期指标,以评价其有效性与安全性。方法计算机检索中国知网、万方数据知识服务平台、中国生物医学文献数据库、Web of Science、Cochrane Library、EMbase、PubMed、Clinicaltrials.gov,收集有关胸腔镜肺段切除术中吲哚菁绿荧光法及改良膨胀萎陷法对照研究的相关文献,检索时限为2000年1月1日—2023年5月1日,应用Stata14MP、RevMan5.4对符合纳入标准的文献数据进行Meta分析。结果共纳入10篇文献,包括1156例患者。胸腔镜解剖性肺段切除术中吲哚菁绿荧光法的安全性及有效性优于改良膨胀萎陷法,其术后总并发症发生率降低[OR=0.51,95%CI(0.36,0.71),P<0.0001]、术后肺漏气发生率降低[OR=0.50,95%CI(0.31,0.80),P=0.004]、手术时间缩短[MD=–25.81,95%CI(–29.78,–21.84),P<0.00001]、术后住院时间缩短[MD=–0.98,95%CI(–1.57,–0.39),P=0.001]、段间交界线清晰显示率升高[OR=5.79,95%CI(2.76,12.15),P<0.00001],差异均有统计学意义。结论相比改良膨胀萎陷法,吲哚菁绿荧光法可更快速、清晰地显示段间交界线,降低手术难度,缩短手术时间和住院时间,降低并发症发生率,为靶肺段精确切除提供有力的技术支持,是一种安全有效的方法,值得在临床上积极推广应用。

Objective To evaluate the effectiveness and safety of indocyanine green fluorescence method versus modified inflation-deflation method for thoracoscopic anatomic segmentectomy.Methods CNKI,Wanfang Database,China Biomedical Literature Database,Web of Science,Cochrane Library,EMbase,PubMed,Clinicaltrials.gov,were searched from 1 January 2000 to 1 May 2023,and controlled studies between indocyanine green fluorescence and modified inflation deflation method in thoracoscopic segmentectomy were collected.Meta-analysis was performed using Stata14MP and RevMan5.4.Results A total of 10 articles,including 1156 patients,were identified.In thoracoscopic anatomic segmentectomy,indocyanine green fluorescence method had an advantage over modified inflation deflation method.The total incidence of postoperative complications decreased(OR=0.51,95%CI 0.36 to 0.71,P<0.0001).The incidence of air leaks decreased(OR=0.50,95%CI 0.31 to 0.80,P=0.004),the operation time shortened(MD=−25.81,95%CI−29.78 to−21.84,P<0.00001),the length of postoperative hospital stays shortened(MD=−0.98,95%CI−1.57 to−0.39,P=0.001),the rate of clear displaying for intersegmental boundary line increased(OR=5.79,95%CI 2.76 to 12.15,P<0.00001).The difference was statistically significant.Conclusion Compared with modified inflation deflation method,indocyanine green fluorescence method can quickly and clearly display the intersegmental boundary line,reduce the difficulty of surgery,shorten the operation time,reduce the length of postoperative hospital stay,and provide reliably technical support for thoracoscopic anatomic segmentectomy.It is an effective and safe method,which is worthy of extensive application.