肺亚段与肺段切除术治疗肺部小结节近期疗效及安全性的系统评价与Meta分析

Short-term efficacy and safety of pulmonary subsegmentectomy versus segmentectomy in the treatment of patients with small pulmonary nodules:A systematic review and meta-analysis

目的系统评价肺亚段与肺段切除术治疗肺部小结节的近期疗效和安全性。方法通过计算机检索PubMed、The Cochrane Library、EMbase、Scopus、Web of Science、SinoMed、中国万方、维普和中国知网数据库,搜集建库至2024年4月公开发表的关于肺亚段切除术和肺段切除术治疗肺部小结节近期疗效与安全性的相关文献。由两位研究员独立按照纳入与排除标准筛选文献并提取资料。采用RevMan 5.4软件进行Meta分析,并使用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对所选文献进行质量评估。结果最终纳入15项回顾性队列研究,共2417例患者,其中796例患者行肺亚段切除,1621例患者行肺段切除。文献NOS评分均≥6分。Meta分析结果显示:与肺段切除术相比,肺亚段切除术的术后总体并发症发生率更低[OR=0.54,95%CI(0.39,0.75),P<0.01]、淋巴结清扫个数少[MD=-0.43,95%CI(-0.81,-0.06),P=0.02];两组手术方式在手术时间[MD=5.11,95%CI(-4.02,14.23),P=0.27]、术中出血量[MD=-14.62,95%CI(-29.58,0.34),P=0.06]、术后住院时间[MD=-0.24,95%CI(-0.49,0.01),P=0.06]、术后引流时间[MD=-0.14,95%CI(-0.46,0.18),P=0.40]、术中切缘宽度[MD=0.10,95%CI(-0.16,0.35),P=0.46]、复发率[OR=1.57,95%CI(0.53,4.61),P=0.42]方面差异无统计学意义。亚组分析结果表明,在使用单孔电视胸腔镜进行手术时,与肺段切除术相比,肺亚段切除术的术中出血量更少[MD=-15.57,95%CI(-28.84,-2.30),P=0.02]、术后住院时间更短[MD=-0.49,95%CI(-0.63,-0.35),P<0.01]、术后引流时间更短[MD=-0.19,95%CI(-0.35,-0.03),P=0.02]、术后总并发症发生率更低[OR=0.55,95%CI(0.31,0.98),P=0.04]。结论肺亚段切除术可获得与肺段切除术相似的疗效,且术后总体并发症发生率低。肺亚段切除能达到和肺段切除相近的切缘范围。术中行单孔胸腔镜操作时,肺亚段切除在术中出血量、术后住院时间及引流时间上较肺段切除更具优势。

Objective To systematically evaluate the short-term efficacy and safety of lung subsegmentectomy and segmentectomy in the treatment of small pulmonary nodules.Methods Computer searches were conducted on PubMed,The Cochrane Library,EMbase,Scopus,Web of Science,SinoMed,Wanfang Data,VIP,and CNKI databases to collect relevant literature on the short-term efficacy and safety of lung subsegmentectomy and segmentectomy for small pulmonary nodules from the inception to April 2024.Two researchers independently screened the literature and extracted data according to inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.4 software,and the Newcastle-Ottawa Scale(NOS)was used to assess the quality of the selected literature.Results A total of 15 retrospective cohort studies with 2417 patients were included,among whom 796 patients underwent lung subsegmentectomy and 1621 patients underwent segmentectomy.The NOS scores of the included literature were all≥6 points.Meta-analysis results showed that compared with segmentectomy,lung subsegmentectomy had a lower overall postoperative complication rate[OR=0.54,95%CI(0.39,0.75),P<0.01]and fewer lymph nodes dissected[MD=−0.43,95%CI(−0.81,−0.06),P=0.02].There was no statistical difference between the two surgical methods in terms of operation time[MD=5.11,95%CI(−4.02,14.23),P=0.27],intraoperative blood loss[MD=−14.62,95%CI(−29.58,0.34),P=0.06],postoperative hospital stay[MD=−0.24,95%CI(−0.49,0.01),P=0.06],postoperative drainage time[MD=−0.14,95%CI(−0.46,0.18),P=0.40],intraoperative margin width[MD=0.10,95%CI(−0.16,0.35),P=0.46],or recurrence rate[OR=1.57,95%CI(0.53,4.61),P=0.42].Subgroup analysis results showed that when using uniportal video-assisted thoracoscopy for surgery,compared with segmentectomy,lung subsegmentectomy had less intraoperative blood loss[MD=−15.57,95%CI(−28.84,−2.30),P=0.02],shorter postoperative hospital stay[MD=−0.49,95%CI(−0.63,−0.35),P<0.01],shorter postoperative drainage time[MD=−0.19,95%CI(−0.35,−0.03),P=0.02],and lower overall complication rate[OR=0.55,95%CI(0.31,0.98),P=0.04].Conclusion Lung subsegmentectomy can achieve similar efficacy as segmentectomy and has a lower overall postoperative complication rate.In terms of safety,lung subsegmentectomy can achieve a margin range close to that of segmentectomy.When performing uniportal thoracoscopic surgery,lung subsegmentectomy has advantages over segmentectomy in terms of intraoperative blood loss,postoperative hospital stay,and drainage time.