微创肺段切除与肺叶切除治疗ⅠA期非小细胞肺癌的系统评价与Meta分析  

Minimally invasive segmentectomy versus lobectomy for stageⅠA non-small cell lung cancer: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12期1838-1845,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：目的系统评价微创肺段切除(minimally invasive lung segment resection,MILSR)与微创肺叶切除(minimally invasive lung lobe resection,MILLR)治疗ⅠA期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床效果,为临床决策提供参考和依据。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,收集有关胸腔镜或机器人辅助肺段切除与肺叶切除治疗ⅠA期NSCLC临床效果比较的文献,检索时限为建库至2023年1月21日。由2名检索人员独立筛选文献、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。预后指标包括总生存期、无病生存期、无复发生存期。使用STATA 14.0软件进行Meta分析。结果共纳入13个研究,包括1853例患者,纳入文献NOS评分≥7分。Meta分析结果显示,与MILLR相比,MILSR术中出血量更少[SMD=−0.36,95%CI(−0.49,−0.23),P<0.001],术后引流管留置时间更短[SMD=−0.34,95%CI(−0.62,−0.05),P=0.019],术后住院时间更短[SMD=−0.28,95%CI(−0.40,−0.15),P<0.001];MILLR在淋巴结清扫数目[SMD=−0.65,95%CI(−0.78,−0.53),P<0.001]及手术时间[SMD=0.20,95%CI(0.07,0.33),P=0.003]方面优于MILSR。两组术后并发症发生率、术后复发率、总生存期、无病生存期及无复发生存期差异均无统计学意义(P>0.05)。结论尽管MILSR较MILLR清扫的淋巴结数量有限,但并不影响预后,且MILSR在减少术中出血量、缩短术后引流管留置时间及住院时间方面更具优势,MILSR对于ⅠA期NSCLC的外科治疗可能是一种更合适的手术方式。Objective To systematically evaluate the clinical outcomes of minimally invasive lung segment resection(MILSR)and lobe resection(MILLR)for stageⅠA non-small cell lung cancer(NSCLC)to provide reference for clinical application.Methods Online databases including The Cochrane Library,PubMed,EMbase,Web of Science,SinoMed,CNKI,and Wanfang were searched from inception to January 21,2023 by two researchers independently.The quality of the included literature was evaluated using the Newcastle-Ottawa Scale(NOS).The prognostic indicators included the overall survival(OS),disease-free survival(DFS)and recurrence-free survival(RFS).The meta-analysis was performed using STATA 14.0.Results A total of 13 studies with 1853 patients were enrolled in the final study,with NOS scores≥7 points.The results of meta-analysis showed that compared with the MILLR group,the blood loss was less[SMD=−0.36,95%CI(−0.49,−0.23),P<0.001],postoperative drainage tube retention time[SMD=−0.34,95%CI(−0.62,−0.05),P=0.019]and hospitalization time[SMD=−0.28,95%CI(−0.40,−0.15),P<0.001]were shorter in the MILSR group.More lymph nodes[SMD=−0.65,95%CI(−0.78,−0.53),P<0.001]and shorter operation time[SMD=0.20,95%CI(0.07,0.33),P=0.003]were found in the MILLR group.There were no statistical differences in the incidence of postoperative complications,postoperative recurrence rate,OS,DFS or RFS between the two groups.Conclusion Although the number of lymph nodes removed by MILSR is limited compared with MILLR,it does not affect the prognosis.MILSR has advantages in reducing intraoperative blood loss and shortening postoperative drainage tube retention time and hospital stay.For the surgical treatment of stageⅠA NSCLC,MILSR may be a more appropriate surgical approach.

关 键 词：肺段切除术 肺叶切除术 非小细胞肺癌 机器人辅助胸腔镜手术 电视辅助胸腔镜手术 系统评价/META分析 

分 类 号：R734.2[医药卫生—肿瘤]