胸腔镜和开胸手术在临床Ⅰ期肺癌淋巴结清扫中效果比较的meta分析
Comparison of lymph node dissection of video-assisted thoracoscopic surgery and thoracotomy in the treatment of clinical stage Ⅰ lung cancer: a meta-analysis and system review
目的 分析对比胸腔镜手术(video-assisted thoracic surgery,VATS)与开胸手术在临床Ⅰ期肺癌淋巴结清扫上的效果差异.方法 按照Cochrane系统评价制作方法,通过PubMed、Ovid Medline、Embase、Web of Science、ScienceDirect、the Cochrane Library、Scopus数据库及Google Scholar搜索VATS和开胸手术治疗临床Ⅰ期肺癌的对比研究,运用RevMan 5.3软件分析两组间淋巴结清扫相关数据.结果 经过筛选,纳入23篇文献,共5 662例患者,其中VATS组2316例,开胸手术组3 346例.Meta分析结果显示,VATS组总淋巴结清扫数(95% CI:-1.64~-0.60,P<0.0001)、总淋巴结清扫站数(95%CI:-0.61~-0.01,P=0.04)及N1淋巴结清扫数(95% CI:-0.28~-0.02,P=0.02)少于开胸手术组,但左侧淋巴结清扫数多于开胸手术组(95% CI:O.51~ 3.22,P=0.007).两组N2淋巴结清扫数(95% CI:-0.74~0.15,P=0.20)、N2淋巴结清扫站数(95% CI:-0.20~0.14,P=0.76)、右侧淋巴结清扫数(95% CI:-1.52~2.23,P=0.71)差异均无统计学意义.结论 在临床Ⅰ期肺癌手术治疗中,VATS手术总淋巴结清扫数、总淋巴结清扫站数及N1淋巴结清扫数少于开放手术,但更适合左侧淋巴结清扫,右侧淋巴结清扫能够达到与传统开胸手术类似的效果,上述结果仍需更多高质量大样本随机对照研究进行验证.
更多Objective To compare the efficacy of lymph nodes(LNs) dissection between video-assisted thoracic surgery (VATS) and thoracotomy in the treatment of clinical stage Ⅰ lung cancer.Methods A comprehensive search of PubMed,Ovid Medline,EMBASE,Web of Science,ScienceDirect,the Cochrane Library,Scopus database and Google Scholar was performed to identify studies comparing VATS and thoracotomy in LNs dissection.The data was analyzed by RevMan 5.3 software and SPSS 18.0.Results After selection,23 articles met the inclusion criteria.2 316 patients were involved in VATS group and 3 346 patients were involved in Open group.Meta analysis showed that less total LNs(95% CI:-1.64--0.60,P < 0.0001),totalLNsstations(95%CI:-0.61--0.01,P=0.04) andN1 LNs(95%CI:-0.28--0.02,P=0.02)were dissected in VATS group.On the left side,more LNs were dissected in VATS group(95% CI:0.51-3.22,P =0.007).The same number of mediastinal LNs (95% CI:-0.74-0.15,P =0.20),mediastinal LNs stations (95% CI:-0.20-0.14,P =0.76),right side LNs (95 % CI:-1.52-2.23,P =0.71) were harvested in both groups.Conclusion In the surgical treatment of clinical stage Ⅰ lung cancer,less total LNs,total LNs stations and N1 LNs were dissected in VATS group,while more left side LNs were harvested by VATS.The same number of mediastinal LNs,mediastinal LNs stations right side LNs were harvested in the two groups.This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
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