论文部分内容阅读
目的分析对比电视胸腔镜手术(VATS)与开胸手术在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,检索Pub Med、Ovid Medline、EMbase、Web of Science、Science Direct、The Cochrane Library、Scopus数据库及Google Scholar收集胸腔镜和开胸手术治疗肺癌的临床研究(1990年1月1日至2015年7月20日),运用Newcastle-Ottawa评分量表及Jadad评分量表对纳入文献进行质量评估,采用RevMan 5.3软件系统分析两组间淋巴结清扫相关数据。结果共纳入51篇文献,其中高质量文献38篇,中等质量文献13篇。共纳入患者16 344例,其中VATS组7 127例,开胸手术组(Open组)9 217例。Meta分析结果显示,VATS组在总淋巴结清扫数(95%CI-1.81~0.28,P=0.15)、总淋巴结清扫站数(95%CI-0.34~0.15,P=0.44)、N_2淋巴结清扫数(95%CI-1.77~0.79,P=0.45)、N_2淋巴结清扫站数(95%CI-0.22~0.16,P=0.78)、N_1淋巴结清扫数(95%CI-0.95~0.11,P=0.12)、右侧淋巴结清扫数(95%CI-1.52~2.23,P=0.71)与Open组的差异均无统计学意义。在N_1淋巴结清扫站数上Open组优于VATS组(95%CI-0.23~-0.04,P=0.005),左侧淋巴结清扫数上VATS组优于Open组(95%CI 0.51~3.22,P=0.007)。结论在肺癌治疗中,胸腔镜手术能够达到与传统开胸手术类似的淋巴结清扫效果,上述结果仍需更多高质量大样本随机对照试验进行验证。
Objective To analyze the differences between the VATS and the thoracic surgery in lymph node dissection of lung cancer. Methods According to the method of Cochrane systematic review, Pub Med, Ovid Medline, EMbase, Web of Science, Science Direct, The Cochrane Library, Scopus database and Google Scholar’s clinical study of thoracoscope and thoracotomy for lung cancer were searched (January 1990 From January 1 to July 20, 2015, the quality of the included literature was assessed using the Newcastle-Ottawa and the Jadad Rating Scale, and the RevMan 5.3 software was used to analyze data on lymph node dissection between the two groups. Results A total of 51 articles were included, of which 38 were high quality literature and 13 were middle quality literature. A total of 16,344 patients were enrolled, including 7,127 in the VATS group and 9,217 in the open-chest group (Open group). Meta-analysis showed that the total number of lymph node dissection (95% CI-1.81-0.28, P = 0.15), the number of total lymph node dissection stations (95% CI -0.34-0.15, P = 0.44), the number of N 2 lymph node dissection 95% CI-1.77-0.79, P = 0.45), N 2 lymph node count (95% CI -0.222-0.16, P = 0.78), N 1 lymph node count There was no significant difference in the number of right lymph nodes (95% CI-1.52-2.23, P = 0.71) and Open group. The numbers of lymph node dissection in the left group were superior to those in the open group in the Open group (95% CI 0.51-3.22, P = 0.007). Conclusion In the treatment of lung cancer, thoracoscopic surgery can achieve the same effect of lymph node dissection as traditional thoracic surgery. The above results still need more high-quality large-scale randomized controlled trials to verify.