电视胸腔镜下与传统开胸下行肺叶切除术治疗非小细胞肺癌临床疗效对比的Meta分析

目的对电视胸腔镜(VATS)与传统开胸(OPEN)两种术式对非小细胞肺癌(综合分期Ⅰ、Ⅱ期)行肺叶切除术的综合临床效益进行系统评价。方法按照Cochrane系统评价制作方法,计算机检索PubMed、EMBASE、Medline、同方数据库相关文献,结合手工检索收集相关文献,采用Cochrane协作网提供的RevMan5.0软件对相关研究数据进行Meta分析,以获得非小细胞肺癌(综合分期Ⅰ、Ⅱ期)在VATS下行肺叶切除术的临床疗效与OPEN下相比有无优势的相关证据。结果经过全面检索及筛查后,共纳入17篇回顾性临床对照研究,共计1586例患者,Meta分析表明:针对非小细胞肺癌(综合分期Ⅰ、Ⅱ期),与OPEN术相比,VATS能减低术后全身P=0.03,优势比(OR)=0.57,95%可信区间(CI)0.34～0.96]和肺部(P=0.001,OR=0.34,95%CI0.17～0.66)并发症的发生率、减少五年死亡率(P=0.0005,OR=0.43,95%CI0.27～0.69)、至研究终点总死亡率(P=0.0004,OR=0.46,95%CI0.30～0.70)和肿瘤复发率(P=0.02,OR=0.63,95%CI0.42～0.94)。结论针对非小细胞肺癌(综合分期Ⅰ、Ⅱ期),与OPEN术相比,VATS能明显减少术后全身尤其是肺部并发症的发生率、减少五年死亡率、总死亡率和肿瘤复发率。

Comparing clinical effect of video-assisted thoracic surgery and traditional thoracotomy in lobectomy of non-small cell lung cancer-Meta analysis and system review

Objective To systematic review the clinical effect of video-assested thoracic sugery(VATS)and traditional open-chest in lobectomy treatment of non-small cell lung cancer(NSCLC,stageⅠandⅡ).Methods According to Cochrane systematic review production method,Pubmed,Ovid,EMBASE,Medline large databases were searched.We also searched related journals,language restricted in English and Chinese.Find all posts related to the network and unpublished case-control experiment and retrieval methods such as manually collecting relevant literature.All references to future literature search.Using the Revman5.0 Cochrane collaboration Meta analysis software,found weather the advantages evidence of the clinical effect of VATS and traditional open-chest in lobectomy treatment of NSCLC(stageⅠandⅡ).Results After a thorough search and screening,a total of 17 case-control trial,a total of 1586 patients,meta analysis showed that:For NSCLC(stageⅠandⅡ),compared with traditional thoracotomy,VATS can significantly reduce the postoperative incidence of complications of the whole body(P=0.03,OR=0.57,95% CI 0.34-0.96),and lung(P=0.001,OR=0.34,95% CI 0.17-0.66),reduce five-year mortality(P=0.0005,OR=0.43,95% CI 0.27-0.69),total mortality(P=0.0004,OR=0.46,95% CI 0.30-0.70)and recurrence rate(P=0.02,OR=0.63,95% CI 0.42-0.94).Conclusions Compared with traditional thoracotomy,VATS can significantly reduce the postoperative incidence of complications of the whole body and lung,five-year mortality,total mortality and recurrence rate.