充气式纵隔镜联合腹腔镜与微创经胸食管切除术治疗食管癌短期疗效及安全性的系统评价与Meta分析  

Short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy and minimally invasive transthoracic esophagectomy for esophageal cancer:A systematic review and meta-analysis

作　　者：李可勇 成涛 金大成 叶智博 阙昌浩 王亚平 柏启州 LI Keyong;CHENG Tao;JIN Dacheng;YE Zhibo;QUE Changhao;WANG Yaping;BAI Qizhou(The First Clinical Department of Gansu University of Traditional Chinese Medicine,Lanzhou,730000,P.R.China;Department of Thoracic Surgery,Gansu Provincial Hospital,Lanzhou,730000,P.R.China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730000 [2]甘肃省人民医院胸外科,兰州730000

出　　处：《中国胸心血管外科临床杂志》2024年第7期1027-1034,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省人民医院院内项目(21GSSYC-40);甘肃省青年科技基金(22JR11RA241);兰州市人才创新创业项目(2021-RC-108)。

摘　　要：目的 比较充气式纵隔镜联合腹腔镜(inflatable video-assisted mediastinoscopic transhiatal esophagectomy,IVMTE)和微创经胸食管切除术(minimally invasive transthoracic esophagectomy,MITE)治疗食管癌的短期疗效及安全性。方法 计算机检索PubMed、EMbase、The Cochrane Library、中国知网、万方和维普数据库,搜索建库至2023年12月公开发表、比较IVMTE与MITE治疗食管癌疗效及安全性的相关文献。采用纽卡斯尔-渥太华量表(The Newcastle-Ottawa Scale,NOS)评价病例对照研究或队列研究的质量,采用Cochrane评价手册对随机对照试验质量进行评价。使用Review Manager 5.4软件进行Meta分析。结果 共纳入14个研究(12个病例对照研究、1个前瞻性队列研究,NOS评分≥7分;1个随机对照试验,偏倚风险低),包括1 163例患者,其中IVMTE组525例,MITE组638例。Meta分析结果显示:IVMTE组手术时间[MD=-60.42,95%CI(-83.78,-37.07),P<0.001]、术后住院时间[MD=-2.44,95%CI(-2.93,-1.94),P<0.01]较MITE组短;术中出血量[MD=-34.67,95%CI(-59.11,-10.23),P=0.005]、术后3 d总引流量[MD=-286.66,95%CI(-469.93,-103.40),P=0.002]、术后肺部感染率[OR=0.38,95%CI(0.26,0.56),P<0.001]、肺漏气发生率[OR=0.12,95%CI(0.02,0.63),P=0.01]和总并发症发生率[MD=0.41,95%CI(0.22,0.75),P=0.004]较MITE组低或少;而在术中淋巴结清扫数量[MD=-3.52,95%CI(-6.36,-0.68),P=0.02]、术中喉返神经损伤[OR=1.78,95%CI(1.22,2.60),P=0.003]方面MITE组更具有优势;而两组吻合口瘘差异无统计学意义。结论 与MITE相比,IVMTE手术时间更短、术中出血量更少、住院时间更短、术后3 d总引流量更少、肺部并发症发生率更低;而在喉返神经损伤、淋巴结清扫数量方面MITE术式更具有优势。Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy(IVMTE) and minimally invasive transthoracic esophagectomy(MITE) in the treatment of esophageal cancer.Methods The Cochrane Library,EMbase,PubMed,Wanfang Database,VIP,and CNKI were searched.Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4.Quality of case control study or cohort study was assessed by the NewcastleOttawa Scale(NOS) and quality of randomized controlled trial was assessed by Cochrane Handbook.Results A total of14 studies(12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk) were included,comprising 1 163 patients,with 525 in the IVMTE group and 638 in the MITE group.The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time[MD=-60.42,95%CI(-83.78,-37.07),P<0.001] and postoperative hospital stay [MD=-2.44,95%CI(-2.93,-1.94),P<0.01] compared to the MITE group.Moreover,intraoperative blood loss [MD=-34.67,95%CI(-59.11,-10.23),P=0.005],three-day postoperative drainage [MD=-286.66,95%CI(-469.93,-103.40),P=0.002],incidence of postoperative pulmonary infection [OR=0.38,95%CI(0.26,0.56),P<0.001],lung leakage rate [OR=0.12,95% CI(0.02,0.63),P=0.01] and overall complication rate [MD=0.41,95%CI(0.22,0.75),P=0.004] were all lower in the IVMTE group compared to those in the MITE group.However,the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number [MD=-3.52,95%CI(-6.36,-0.68),P=0.02] and intraoperative recurrent laryngeal nerve injury [OR=1.78,95%CI(1.22,2.60),P=0.003].No significant difference was observed between both methods concerning anastomotic fistula.Conclusion Compared to MITE,IVMTE has advantages such a

关 键 词：充气式纵隔镜 微创食管切除术 食管癌 系统评价/META分析 

分 类 号：R735.1[医药卫生—肿瘤]