经剑突下与经肋间入路胸腔镜手术治疗前纵隔肿瘤围术期结果的系统评价与Meta分析  

Perioperative outcomes of subxiphoid versus intercostal thoracoscopic surgery for anterior mediastinal tumors:A systematic review and meta-analysis

作　　者：曾伟强 党海丽 苟云久[3] ZENG Weiqiang;DANG Haili;GOU Yunjiu(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou,730000,P.R.China;Department of Gastroenterology,Longnan Hospital of Traditional Chinese Medicine,Longnan,746000,Gansu,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]甘肃省陇南市中医医院消化科,甘肃陇南746000 [3]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10期1514-1521,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省中医药科研课题(GZKZ-2020-1);甘肃省人民医院国家自然科学基金抚育项目(19SYPYB-28,19SYPYB-16)。

摘　　要：目的系统评价经剑突下入路胸腔镜手术(subxiphoid video-assisted thoracoscopic surgery,SVATS)与经肋间入路胸腔镜手术(intercostal video-assisted thoracoscopic surgery,IVATS)治疗前纵隔肿瘤围术期的临床效果差异。方法计算机检索The Cochrane Library、PubMed、EMbase、Web of Science、Sinomed、中国知网及万方数据库,筛选有关SVATS与IVATS治疗前纵隔肿瘤临床效果比较的文献,检索时限为建库至2022年12月19日。两位研究员独立筛选文献、提取相关数据。对纳入的文献采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行质量评价。使用RevMan 5.3软件进行Meta分析。结果共纳入12个研究,包括1517例患者。NOS评分≥6分。Meta分析结果显示,与IVATS相比,SVATS术中出血量更少[MD=-17.76,95%CI(-34.21,-1.31),P=0.030],术后引流总量更少[MD=-70.46,95%CI(-118.88,-22.03),P=0.004],术后引流管留置时间更短[MD=-0.84,95%CI(-1.57,-0.10),P=0.030],术后肺部感染发生率更低[OR=0.33,95%CI(0.16,0.70),P=0.004],术后24 h[MD=-1.95,95%CI(-2.64,-1.25),P<0.001]、72 h[MD=-1.76,95%CI(-2.55,-0.97),P<0.001]疼痛视觉模拟评分更低,术后住院时间更短[MD=-1.12,95%CI(-1.80,-0.45),P=0.001]。两组手术时间、术后总并发症发生率、术后膈神经麻痹发生率、术后心律失常发生率差异均无统计学意义(P>0.05)。结论SVATS治疗前纵隔肿瘤具有较高的安全性。与IVATS相比,患者术中失血量及术后引流量更少、术后发生肺部感染的风险更低、术后短期疼痛更轻、术后引流管留置时间及住院时间更短,更有利于患者术后快速康复。Objective To systematically evaluate the difference in clinical outcomes between subxiphoid videoassisted thoracoscopic surgery(SVATS)and intercostal video-assisted thoracoscopic surgery(IVATS)for anterior mediastinal tumor resection.Methods Online databases including The Cochrane Library,PubMed,EMbase,Web of Science,Sinomed,CNKI,Wanfang from inception to December 19,2022 were searched by two researchers independently for literature comparing the clinical efficacy of SVATS and IVATS in treating anterior mediastinal tumors.Two researchers independently screened literature and extracted relevant data.The quality of the included literature was evaluated using the Newcastle-Ottawa Scale(NOS).The meta-analysis was performed by RevMan 5.3.Results A total of 12 studies with 1517 patients were enrolled.NOS score≥6 points.The results of meta-analysis showed that compared with the IVATS,SVATS had less blood loss(MD=−17.76,95%CI−34.21 to−1.31,P=0.030),less total postoperative drainage volume(MD=−70.46,95%CI−118.88 to−22.03,P=0.004),shorter duration of postoperative drainage tube retention(MD=−0.84,95%CI−1.57 to−0.10,P=0.030),lower rate of postoperative lung infections(OR=0.33,95%CI 0.16 to 0.70,P=0.004),lower postoperative 24 h VAS pain score(MD=−1.95,95%CI−2.64 to−1.25,P<0.001)and 72 h VAS pain score(MD=−1.76,95%CI−2.55 to−0.97,P<0.001),and shorter postoperative hospital stay(MD=−1.12,95%CI−1.80 to−0.45,P=0.001).There was no statistical difference in the operation time,the incidence of postoperative complications,incidence of postoperative phrenic nerve palsy or incidence of postoperative arrhythmia(P>0.05).Conclusion SVATS for the treatment of anterior mediastinal tumors has high safety.Compared with the IVATS,the patients have less intraoperative blood loss and postoperative drainage volume,lower risk of postoperative pulmonary infection,less postoperative shortterm pain,and shorter postoperative catheter duration and hospital stay,which is more conducive to rapid postoperative recov

关 键 词：电视胸腔镜手术 前纵隔肿瘤 微创手术 经剑突下入路 系统评价/META分析 

分 类 号：R734.5[医药卫生—肿瘤]