胸腔镜下和传统开胸手术治疗早期非小细胞肺癌的Meta分析

目的用Meta分析方法对国内外已发表的高质量的有关比较电视辅助胸腔镜手术（VATS）和传统开胸手术治疗早期非小细胞肺癌的疗效的临床研究进行综合定量分析。方法按Cohrane系统评价方法，计算机检索Cochrane图书馆，Cochrane协作网数据库，MEDLINE，EMBASE，中国生物医学文献数据库，PUBMED，万方数据库和维普数据库，同时手工检索中文期刊的相关文献，收集已公开发表的有关比较VATS和传统开胸手术治疗早期非小细胞肺癌的随机对照研究实验（RCT），并评价纳入研究的方法学质量。统计软件采用Cochrane协作网提供的RevMan5．025。结果纳入VATS和传统开胸手术比较治疗早期非小细胞肺癌的RCT文献4篇，共954例。Meta分析显示：与传统开胸手术治疗相比较，VATS趋向于取得更好的生存率，可彻底完成系统性淋巴结清扫，并降低术后总的并发症发生率，缩短手术时间、术后住院时间、术后胸管引流时间及漏气并发症发生率。结论现有的临床资料显示：相比于开胸手术，VATS是治疗早期非小细胞肺癌更好的选择，可以作为早期非小细胞肺癌的常规治疗手段。但因研究质量和研究样本的局限性，上述结论仍有待设计严谨的大样本随机对照试验再加以验证。

Video-assisted thoracic surgery versus traditional open lobectomy for early stage non-small cell lung cancer: a Meta-analysis

Objective To determine the effect of video-assisted thoracic surgery （VATS） versus traditional open lobectomy for early stage non-small cell lung cancer. Methods The Cochrane library, MEDLINE, EM- BASE, CBM and the relevant English and Chinese journals were searched for the randomized controlled trims （RCT） of VATS versus traditional open lobectomy for early stage non-small cell lung cancer. The systematic re- view was performed using the method recommended by the Cochrane Collaboration. Results 4 randomized con- trolled trials were included, revolving 954 patients. Compared with open lobectomy, the results of Meta-analysis showed VATS： （1） trend to obtain better clinical results towards survival rate; （2） can thoroughly complete sys- temic lymph node dissection; （3） reduced the total complication rate postoperatively; （4） reduced the operative time; （5） decreased the time of mean inpatient stay; （6） and reduced the time of chest tube drainage and inci- dence of air leak postoperatively. Condusions The limited clinical trials show there is some evidence supporting the use of video-assisted thoracic surgery and maybe VATS is a good alternative to traditional open lobeetomy.However, more high quality, large-scale randomized clinical trials are required for more accurate conclusions.