单孔与三孔胸腔镜肺叶切除术治疗非小细胞肺癌的围术期结果:一项基于随机对照试验的系统评价与Meta分析  

Comparison of perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer:A systematic review and meta-analysis of randomized controlled trials

作　　者：沈忠忠 周柯 林华杭 曹杰 梁林川 王磊[1] 彭智愚 梅建东[1] SHEN Zhongzhong;ZHOU Ke;LIN Huahang;CAO Jie;LIANG Linchuan;WANG Lei;PENG Zhiyu;MEl Jiandong(Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2022年第10期1367-1375,共9页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目(ZYJC18009)。

摘　　要：目的比较单孔和三孔胸腔镜肺叶切除术治疗非小细胞肺癌的围术期结果。方法计算机检索PubMed、Web of Science、EMbase、知网、万方数据库,检索时限为建库至2022年4月。由两名研究人员独立进行文献筛选、数据提取和偏倚风险评价,利用RevMan 5.3和Stata 16.0进行数据分析。使用Cochrane偏倚风险评估工具评价纳入研究的偏倚风险。结果共纳入18篇随机对照研究,共计1597例患者,其中800例患者进行了单孔胸腔镜肺叶切除术(单孔组),797例患者进行了三孔胸腔镜肺叶切除术(三孔组)。Meta分析结果显示:相较于三孔组,单孔组手术时间更长[WMD=7.63,95%CI(2.36,12.91),P=0.005],但术中出血量少于三孔组[WMD=–28.81,95%CI(–42.54,–15.08),P<0.001]。术后指标方面,单孔组患者术后24 h内疼痛视觉模拟评分更低[WMD=–1.60,95%CI(–2.26,–0.94),P<0.001]、术后胸腔引流量少于三孔组[WMD=–25.30,95%CI(–46.22,–4.37),P=0.020]、术后胸腔引流管留置时间较短[WMD=–0.36,95%CI(–0.72,–0.01),P=0.040]。单孔组患者住院时间明显缩短[WMD=–2.28,95%CI(–2.68,–1.88),P<0.001]、术后并发症发生率低于三孔组[RR=0.49,95%CI(0.38,0.63),P<0.001]。两种术式在清扫淋巴结数量上差异无统计学意义[WMD=–0.01,95%CI(–0.24,0.21),P=0.930]。结论单孔与三孔胸腔镜肺叶切除术治疗非小细胞肺癌同样安全可行,单孔胸腔镜在减轻术后早期疼痛、降低术后并发症发生率和缩短住院时间方面具有优势。Objective To compare the perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer(NSCLC).Methods Electronic databases including PubMed,Web of Science,EMbase,CNKI,Wanfang were systematically searched from the establishment of each database until April 2022.Literature screening,data extraction and bias risk assessment were independently conducted by two researchers.All combined results were performed by RevMan 5.3 and Stata 16.0.The quality of the literature and the risk of bias were evaluated using the Cochrane Bias Risk Assessment Tool.Results Eighteen eligible randomized controlled trials(1597patients)were identified eventually,including 800 patients undergoing uniportal thoracoscopic lobectomy and 797patients undergoing three-portal thoracoscopic lobectomy.Meta-analysis results showed that compared to the three-portal approach,uniportal lobectomy took longer operation time(WMD=7.63,95%CI 2.36 to 12.91,P=0.005)with less intraoperative blood loss(WMD=–28.81,95%CI–42.54 to–15.08,P<0.001).Furthermore,patients undergoing uniportal lobectomy achieved lower visual analogue score within 24 hours after the operation(WMD=–1.60,95%CI–2.26 to–0.94,P<0.001),less volume of drainage after the operation(WMD=–25.30,95%CI–46.22 to–4.37,P=0.020),as well as shorter drainage duration(WMD=–0.36,95%CI–0.72 to–0.01,P=0.040).Besides,patients undergoing uniportal lobectomy were also observed with shorter length of hospital stay(WMD=–2.28,95%CI–2.68 to–1.88,P<0.001)and lower incidence of postoperative complications(RR=0.49,95%CI 0.38 to 0.63,P<0.001).However,the number of lymph nodes harvested during the operation(WMD=–0.01,95%CI–0.24 to 0.21,P=0.930)was similar between the two groups.Conclusion Both uniportal and three-portal thoracoscopic lobectomy for NSCLC are safe and feasible.The uniportal approach is superior in reducing short-term postoperative pain,postoperative complications and shortening the length of hospital stay.

关 键 词：非小细胞肺癌 电视辅助胸腔镜手术 肺叶切除 单孔 多孔 三孔 系统评价/META分析 

分 类 号：R734.2[医药卫生—肿瘤]