中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

肺癌术后单管与双管胸腔闭式引流疗效比较的 Meta 分析

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目的 通过纳入所有已发表的关于比较肺癌术后单管胸腔闭式引流(single tube,ST)与双管胸腔闭式引流(double tube,DT)的随机对照研究(RCT)进行一项 Meta 分析,进一步明确两者之间对肺叶切除术后临床效果的影响。 方法 采用系统评价方法,计算机检索 PubMed、Medline、EMbase、Web of Science、Central、中国知网数据库、万方、维普数据库、中国生物医学,通过预定的检索方案进行文献检索,收集单管与双管引流在肺叶切除术后的文章,收集 RCT,分析 ST 和 DT 对肺叶切除术后的临床效果的影响,并根据纳入和排除标准筛最终选出纳入 Meta 分析的高质量文献,用 RevMan5.3 软件进行 Meta 分析。 结果 一共纳入 12 篇 RCT 研究,合计 1 442 例患者。对比 DT 与 ST 分析如下:(1)术后疼痛评分:[OR=–0.64,95%CI (–0.71,–0.56),P<0.000 01],表明 ST 术后疼痛评分优于 DT;(2)术后拔管时间: [OR=0.30,95%CI(0.15,0.44),P<0.000 01],表明术后 ST 放置时间短于 DT;(3)术后住院时间:[SMD=–0.28,95%CI(–0.40,–0.15),P<0.000 1],表 明 ST 组术后住院时间较 DT 短;(4)术后并发症发生率:[RR=1.11,95%CI(0.83,1.49),P=0.49],表明术后两组并发症发生率无统计学意义;(5)术后重新置管例数:[OR=0.87,95%CI(0.46,1.64),P=0.67],术后两组重新置管无统计学意义;(6)术后漏气:[OR=1.25,95%CI(0.89,1.75),P=0.20],术后漏气无统计学意义。 结论 通过对纳入的 RCT 研究分别进行 Meta 分析,可以认为肺叶切除术后单管引流在术后疼痛,拔管时间,住院时间方面显著优于双管引流,而且单管引流并不增加术后并发症。

Objective To compare the efficacy of single tube (ST) and double tube (DT) after lobectomy through analysis of randomized controlled trials(RCTs). Methods According to recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Medline, EMbase, Web of Science, CNKI, Wanfang Database, VIP database and CMCI to identify articles to include in our meta analysis. Literature search was performed using relevant keywords. A meta-analysis was performed using RevMan software. Results Twelve RCTs included in this meta-analysis, which included 1442 patients, met the selection criteria. From the available data, the patients using ST have significantly decreased postoperative pain (OR=–0.64, 95%CI –0.71~–0.56, P<0.000 01), duration of drainage (OR=0.30, 95%CI 0.15~0.44, P<0.000 01), or hospital stay (SMD=–0.28, 95%CI –0.40~–0.15, P<0.000 1) compared to the patients using DT after a pulmonary lobectomy. Besides, there was no significant difference in postoperative complications (RR=1.11, 95%CI 0.83~1.49, P=0.49), air leaks (OR=1.25, 95%CI 0.89~1.75, P=0.20) and the redrainage rate (0.87, 95%CI 0.46~1.64, P=0.67). Conclusion Our results showed that a single-drain method is effective, reduces postoperative pain, hospitalization times and duration of drainage in patients who undergo lobectomy, moreover, does not increase the occurrence of postoperative complications and redrainage rate.

关键词: 肺癌; 肺叶切除术; 单管胸腔闭式引流; 双管胸腔闭式引流; Meta 分析

Key words: Lung cancer; lobectomy; double tube; double tube; meta-analysis

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