摘要
目的分析对比电视胸腔镜手术(VATS)与开胸手术在肺癌淋巴结清扫上的效果差异。方法按照Cochrane系统评价制作方法,检索Pub Med、Ovid Medline、EMbase、Web of Science、Science Direct、The Cochrane Library、Scopus数据库及Google Scholar收集胸腔镜和开胸手术治疗肺癌的临床研究(1990年1月1日至2015年7月20日),运用Newcastle-Ottawa评分量表及Jadad评分量表对纳入文献进行质量评估,采用RevMan 5.3软件系统分析两组间淋巴结清扫相关数据。结果共纳入51篇文献,其中高质量文献38篇,中等质量文献13篇。共纳入患者16 344例,其中VATS组7 127例,开胸手术组(Open组)9 217例。Meta分析结果显示,VATS组在总淋巴结清扫数(95%CI-1.81~0.28,P=0.15)、总淋巴结清扫站数(95%CI-0.34~0.15,P=0.44)、N_2淋巴结清扫数(95%CI-1.77~0.79,P=0.45)、N_2淋巴结清扫站数(95%CI-0.22~0.16,P=0.78)、N_1淋巴结清扫数(95%CI-0.95~0.11,P=0.12)、右侧淋巴结清扫数(95%CI-1.52~2.23,P=0.71)与Open组的差异均无统计学意义。在N_1淋巴结清扫站数上Open组优于VATS组(95%CI-0.23^-0.04,P=0.005),左侧淋巴结清扫数上VATS组优于Open组(95%CI 0.51~3.22,P=0.007)。结论在肺癌治疗中,胸腔镜手术能够达到与传统开胸手术类似的淋巴结清扫效果,上述结果仍需更多高质量大样本随机对照试验进行验证。
Objective To compare effectiveness and safety of video-assisted thoracic surgery （VATS） and thoracotomy in lymph node （LN） dissection for lung cancer. Methods A comprehensive search of PubMed, Ovid Medline, EMbase, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies （from January 1990 to July 2015） comparing VATS with thoracotomy in LN dissection. The data were analyzed by RevMan 5.3 software. Quality of literature was evaluated by Newcastle-Ottawa scale or Jadad scale. Results Fifty-one articles met the inclusion criteria involved 7 127 patients in the VATS group and 9 217 patients in the thoracotomy group. Thirty-eight articles were of good quality and the remaining thirteen were medium. Meta-analysis showed that fewer N1 LN stations in the VATS group （95% C1-0.23 to -0.04, P=O.O05）, although VATS harvested more left-side LNs （95% CI 0.51 to 3.22, P=0.007）. The number of total LNs （95% C1-1.81 to 0.28, P=0.15）, total LN stations （95% CI -0.34 to 0.15, P=0.44）, N2 LNs （95%CI -1.77 to 0.79, P=0.45）, N2 LN stations （95% CI -0.22 to 0.16, P=0.78）, N1 LNs （95% CI -0.95 to 0.11, P=0.12）, and right-side LNs （95% CI -1.52 to 2.23, P=0.71） harvested in the two groups were not significantly different. Conclusion In the surgical treatment of lung cancer, VATS can achieve the same efficacy of LN dissection as thoracotomy. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2016年第10期992-1000,共9页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家自然科学基金(81160293)~~
关键词
电视胸腔镜手术
开胸手术
肺癌
淋巴结清扫
系统评价/META分析
Video-assisted thoracic surgery
Open surgery
Lung cancer
Lymph node dissection
Systematic review/meta-analysis
