经剑突下单孔与经肋间手术治疗前纵隔肿瘤效果对比——Meta分析

Comparison of the Efficacy of Thoracoscopic Resection via Subxiphoid Single-Foramen Approach and via Intercostal Approach for Anterior Mediastinal Tumors—Meta Analysis

目的:本研究采用荟萃分析评价经剑突下单孔胸腔镜手术与经肋间胸腔镜手术治疗前纵隔肿瘤的效果。方法:计算机检索PubMed、Embase、Cochrane、Web of Science、CNKI、VIP、WanFang数据库,搜集行剑突下单孔入路或肋间入路胸腔镜手术治疗前纵隔肿瘤的随机对照试验和队列研究,检索时限为建库至2022年11月,采用StataSE 15进行Meta分析并绘制相关图表。结果:纳入了9项研究,共涉及AMT手术患者550例,所有研究均发表于2017年至2022年之间。分析结果显示:两种术式在手术时间方面没有显著统计学差异,剑突下单孔入路组对比肋间入路组显著减少或降低了术中出血量、术后引流量、术后引流管留置时间、术后24小时和48小时疼痛评分、住院时间以及术后并发症的发生率。另外还对其中的术后并发症方面进行了更为细致的亚组分析,结果显示剑突下单孔入路组术后肺不张和肺部感染的发生率显著低于肋间入路组,而在术后心律失常方面两组术式间没有显著统计学差异。结论:除手术时间方面,剑突下单孔入路胸腔镜手术治疗前纵隔肿瘤相较于肋间入路术式,在各疗效指标上均显示出了明显的优势,并且当手术医生对手术有一定熟练度后,手术时间也可明显缩短体现出优势,说明剑突下单孔入路胸腔镜手术是安全可行的,值得进一步推广和研究。

Objective: This study used a meta-analysis to evaluate the efficacy of thoracoscopic resection via subxiphoid single-foramen approach and via intercostal approach in the treatment of anterior me-diastinal tumors. Methods: The database of PubMed, Embase, Cochrane, Web of Science, CNKI, VIP and Wan Fang were searched by computer to collect the randomized controlled trial and cohort study of thoracoscopic surgery for anterior mediastinal tumors through subxiphoid single-foramen approach and intercostal approach. The retrieval time limit is from the establishment of the data-base to November 2022. This paper uses StataSE 15 to conduct meta-analysis and draw relevant charts. Results: Nine studies were included, involving 550 patients with AMT surgery, all of which were published between 2017 and 2022. The analysis results showed that there was no significant statistical difference between the two operation methods in terms of operation time. Compared with the intercostal approach group, the subxiphoid single-foramen approach group significantly re-duced the amount of intraoperative bleeding, postoperative drainage flow, postoperative drainage tube retention time, postoperative pain score 24 hours and 48 hours, hospital stay and the inci-dence of postoperative complications. In addition, a more detailed subgroup analysis of postopera-tive complications was carried out. The results showed that the incidence of postoperative atelecta-sis and pulmonary infection in the subxiphoid single-foramen approach group was significantly lower than that in the intercostal approach group, while there was no significant statistical differ-ence between the two groups in terms of postoperative arrhythmia. Conclusion: In addition to the operation time, compared with intercostal approach, thoracoscopic resection via subxiphoid sin-gle-foramen approach in the treatment of anterior mediastinal tumors shows obvious advantages in terms of various therapeutic indicators, and when the surgeon has a certain degree of proficiency in surgery, the operation time can also be significantly shortened, reflecting the advantages, indicating that the subxiphoid single-foramen approach for thoracoscopic surgery is safe and feasible, and is worth further promotion and research.