胸腔镜肺切除术后不留置胸腔引流管安全性和可行性的系统评价与Meta分析  

Safety and feasibility of no chest tube after thoracoscopic pneumonectomy:A systematic review and meta-analysis

作　　者：胡福安 王鹏[1] 李文登 马林冲 李庆新 HU Fuan;WANG Peng;LI Wendeng;MA Linchong;LI Qingxin(The Clinical Medical College of Ningxia Medical University,Yinchuan,750004,P.R.China;The Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou,730000,P.R.China;Department of Cardiothoracic Surgery,The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Lanzhou,730050,P.R.China)

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]甘肃中医药大学临床医学院,兰州730000 [3]联勤保障部队第940医院心胸外科,兰州730050

出　　处：《中国胸心血管外科临床杂志》2022年第11期1503-1510,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省科技重点支撑项目(1104FKCA106)。

摘　　要：目的探讨胸腔镜肺切除术后不留置胸腔引流管(no chest tube,NCT)的安全性和可行性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、维普和万方数据库,搜集关于胸腔镜肺切除术后NCT的研究,检索时限均从建库至2020年10月。由2名评价员独立筛选文献、提取资料和评价纳入研究的质量,采用RevMan 5.3软件进行Meta分析。结果最终纳入17项研究,包括12项队列研究和5项随机对照试验,共计1572例患者,其中NCT组患者779例,留置胸腔引流管(chest tube placement,CTP)组患者793例。Meta分析结果显示:NCT组的术后住院时间明显短于CTP组[SMD=–1.23,95%CI(–1.59,–0.87),P<0.00001];NCT组术后第1 d疼痛评分[SMD=–0.97,95%CI(–1.42,–0.53),P<0.0001]、术后第2 d疼痛评分[SMD=–1.10,95%CI(–2.00,–0.20),P=0.02]低于CTP组,术后第3 d疼痛评分两组差异无统计学意义[SMD=–0.92,95%CI(–1.91,0.07),P=0.07]。两组患者术后30 d并发症发生率[RR=0.93,95%CI(0.61,1.44),P=0.76]、再次行胸腔闭式引流[RR=1.51,95%CI(0.68,3.37),P=0.31]及胸腔穿刺术[RR=2.81,95%CI(0.91,8.64),P=0.07]差异无统计学意义。两组患者围手术期均无死亡发生。结论对于满足条件的患者行胸腔镜肺切除术后NCT是可行和安全的。Objective To discuss the safety and feasibility of no chest tube(NCT)after thoracoscopic pneumonectomy.Methods The online databases including PubMed,EMbase,The Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),WanFang Database,VIP,China Biology Medicine disc(CBMdisc)were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy.Two reviewers independently screened the literature,extracted the data,and evaluated the quality of the included studies.The RevMan 5.3 software was used for meta-analysis.Results A total of 17 studies were included.There were 12 cohort studies and 5 randomized controlled trials including 1572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement(CTP)group.Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group(SMD=–1.23,95%CI–1.59 to–0.87,P<0.00001).Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day(POD)1(SMD=–0.97,95%CI–1.42 to–0.53,P<0.0001),and POD2(SMD=–1.10,95%CI–2.00 to–0.20,P=0.02),while no statistical difference was found between the two groups in the visual analogue scale of POD3(SMD=–0.92,95%CI–1.91 to 0.07,P=0.07).There was no statistical difference in the 30-day complication rate(RR=0.93,95%CI 0.61 to1.44,P=0.76),the rate of postoperative chest drainage(RR=1.51,95%CI 0.68 to 3.37,P=0.31)or the rate of thoracocentesis(RR=2.81,95%CI 0.91 to 8.64,P=0.07)between the two groups.No death occurred in the perioperative period in both groups.Conclusion It is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.

关 键 词：肺切除术 电视辅助胸腔镜手术 胸腔引流 系统评价/META分析 

分 类 号：R655.3[医药卫生—外科学]