中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

单孔法与多孔法胸腔镜下肺叶切除术治疗非小细胞肺癌疗效的系统评价与 Meta 分析

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目的 对单孔法(single-port)与多孔法(multiple-port)胸腔镜下肺叶切除术两种术式治疗非小细胞肺癌的有效性及安全性进行系统评价。 方法 通过计算机检索 PubMed、EMbase、the Cochrane Library、CBM、知网、万方、VIP 以及 web of science 等数据库,检索时间由其建库至 2018 年 8 月。筛选文献、提取资料以及评价偏倚风险由两名研究员独立完成,并对所采集数据使用 RevMan 5.3 软件进行 Meta 分析。 结果 本文共纳入 11 篇研究(4 篇随机对照研究,1 篇前瞻性队列研究,6 篇回顾性队列研究),共计 1 574 例患者,其中单孔法组 779 例,多孔法组 795 例。Meta 分析结果显示:两组在手术时间[MD=3.60,95%CI(–8.59,15.79),P=0.56]、术中中转率[OR=1.06,95%CI(0.54,2.06),P=0.87]、术后住院时间[MD=0.74,95%CI(–1.60,0.12),P=0.09]、术后并发症率[OR=0.76,95%CI(0.53,1.10),P=0.15]、术后引流时间[MD=0.63,95%CI(–1.28,0.02),P=0.06]、清扫淋巴结数[MD=0.50,95%CI(–0.60,–0.41),P=0.54]方面差异无统计学意义;两组在术中出血量[MD=17.12,95%CI(–31.16,–3.08),P=0.02]、术后第 1 d 疼痛评分[MD=–1.03,95%CI(–1.85,–0.75),P<0.000 01]、术后第 3 d 疼痛评分[MD=–0.82,95%CI(–1.00,–0.65),P<0.000 01]方面差异有统计学意义。 结论 单孔法与多孔法胸腔镜下肺叶切除术治疗非小细胞肺癌效果相当;在术中出血量、第 1 d 疼痛评分及第 3 d 疼痛评分方面,单孔组手术较多孔组手术有一定的优势。

Objective To systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery (VATS) and multiple-port VATS in lobectomy treatment of non-small cell lung cancer (NSCLC). Methods The PubMed, EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single-port vs multiple-port VATS for patients with NSCLC from inception to August 2018. The literature was screened, data were extracted and the risk of bias of included studies was assessed independently completed by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software. Results Eleven studies (four randomized controlled trial, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients. Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that the operation time (MD=3.60, 95%CI –8.59 to 15.79, P=0.56), the conversion rate (OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications (OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time (MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time (MD=0.63, 95%CI –1.28 to 0.02, P=0.06) and harvested lymph nodes (MD=0.50, 95%CI –0.60 to –0.41, P=0.54) were not significant difference in both groups. The intraoperative blood loss (MD=17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than the multiple-group. The VAS scores at postopertative first day (MD=–1.03, 95%CI –1.85 to –0.75, P<0.000 01) and at postopertative third day (MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group. Conclusion The meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent; however the intraope rative blood loss, the VAS scores at postopertative first and third days in the single-port group are better.

关键词: 电视胸腔镜; 非小细胞肺癌; 单孔胸腔镜; 多孔胸腔镜; 肺叶切除术; Meta 分析

Key words: Video-assisted thoracoscopic surgery; non-small cell lung cancer; single-port; multiple-port; lobectomy; meta-analysis

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1. Rafiemanesh H, Mehtarpour M, Khani F, et al. Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world. J Thorac Dis, 2016, 8(6): 1094-1102.
2. Hartwig MG, D'Amico TA. Thoracoscopic lobectomy: the gold standard for early-stage lung cancer? Ann Thorac Surg, 2010, 89(6): S2098-S2101.
3. 王继振, 刘公哲, 李大宏. 单孔全胸腔镜下肺叶切除治疗周围型非小细胞肺癌的安全性和有效性. 现代肿瘤医学, 2018, 26(10): 1544-1547.
4. 隆治泉. 单孔与多孔胸腔镜手术对Ⅰ期非小细胞肺癌的临床疗效比较. 临床医药文献电子杂志, 2018, 5(31): 78.
5. 李志强, 宫心明, 韩孔启, 等. 单孔与三孔胸腔镜手术治疗早期非小细胞肺癌患者的疗效比较. 检验医学与临床, 2018, 15(6): 888-890.
6. 马洪飚, 黄伟, 罗锋, 等. 胸腔镜单操作孔法与单孔法行肺叶切除术治疗早期非小细胞肺癌的临床效果比较. 广西医学, 2017, 39(7): 971-973, 986.
7. 尹逊亮, 周勇安, 赵宁, 等. 单孔及多孔法胸腔镜手术治疗周围型非小细胞肺癌临床疗效的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(11): 1044-1049.
8. 石岱旺, 徐然, 韩云, 等. 单孔与三孔胸腔镜肺叶切除术治疗周围型肺癌的临床疗效比较. 中国医科大学学报, 2018, 47(7): 609-611, 616.
9. Song KS, Park CK, Kim JB. Efficacy of single-port video-assisted thoracoscopic surgery lobectomy compared with triple-port VATS by propensity score matching. Korean J Thorac Cardiovasc Surg, 2017, 50(5): 339-345.
10. Shen Y, Wang H, Feng M, et al. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study†. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i48-i53.
11. Dai F, Meng S, Mei L, et al. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis, 2016, 8(10): 2872-2878.
12. Son B.S.; Kim DH Perioperative and mid-term outcomes after single port versus multi-ports thoracoscopic lobectomy for lung cancer: A propensity matching study. J Thorac Oncol, 2017, 1(Suppl 1): S757-S758.
13. Han KN.; Kim HK.; Choi YH Single-port versus multiport thoracoscopic lobectomy in non-small-cell lung cancer: Propensity-score matched analysis. Innovations (Phila), 2017, 12(Suppl 4): S125.
14. Rocco G, Khalil M, Jutley R. Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg, 2005, 129(4): 947-948.
15. Gonzalez D, de la Torre M, Paradela M, et al. Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg, 2011, 40(1): e21-e28.
16. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11: S240-S252.
17. Jensen MP, Karoly P, O'Riordan EF, et al. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.
18. West D, Young R, McElnay P, et al. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact Cardiovasc Thorac Surg, 2015, 20(3): 414.
19. Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
20. 张皓, 齐海, 王磊, 等. 电视胸腔镜与开胸手术治疗非小细胞肺癌随机对照研究的系统评价和Meta分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1087-1094.