CAJ | 학술논문

目的荟萃文献,对比分析非小细胞肺癌行全腔镜肺叶切除术与开胸肺叶切除术淋巴结清扫数目及生存率.方法检索Embase、Medline、Cochrane Central Register of Controlled Trials、Pubmed、Web of Knowledge、中国生物医学文献数据库、中国知网数据库出版平台、万方数据知识服务平台这8个数据库,由2位胸外科医师各自独立地对入选研究的有关试验设计、研究对象特征和研究结果等内容进行摘录,统计分析采用Stata 12.0软件.结果符合纳入标准的文献共12篇,共计1 225例非小细胞肺癌患者,其中接受全腔镜肺叶切除术543例,开胸手术682例.12项研究中前瞻性随机对照研究和回顾性非随机对照研究各6项.分析结果显示,全腔镜肺叶切除术淋巴结清扫数量与开胸肺叶切除术相比无明显统计学差异(汇总分析P=0.599,分亚组分析两亚组分别为P=0.243和P=0.144,按实验设计分析前瞻性随机对照实验P=0.977,回顾性非随机对照实验P=0.696),两组之间复发率无统计学差异(P=0.108),两组间生存无统计学差异(汇总P=0.676,Ⅱ、Ⅲ期为主者P=0.683).全腔镜手术的出血量(P=0.000)及并发症(P=0.007)更少,差异具有统计学意义.各文献手术时间差异较大,无法进行合并.结论全腔镜肺叶切除术用于治疗非小细胞肺癌时是一种安全、有效的术式,即便在进展期的非小细胞肺癌也是如此.
목적 회췌문헌,대비분석비소세포폐암행전강경폐협절제술여개흉폐협절제술림파결청소수목급생존솔.방법 검색Embase、Medline、Cochrane Central Register of Controlled Trials、Pubmed、Web of Knowledge、중국생물의학문헌수거고、중국지망수거고출판평태、만방수거지식복무평태저8개수거고,유2위흉외과의사각자독입지대입선연구적유관시험설계、연구대상특정화연구결과등내용진행적록,통계분석채용Stata 12.0연건.결과 부합납입표준적문헌공12편,공계1 225례비소세포폐암환자,기중접수전강경폐협절제술543례,개흉수술682례.12항연구중전첨성수궤대조연구화회고성비수궤대조연구각6항.분석결과현시,전강경폐협절제술림파결청소수량여개흉폐협절제술상비무명현통계학차이(회총분석P=0.599,분아조분석량아조분별위P=0.243화P=0.144,안실험설계분석전첨성수궤대조실험P=0.977,회고성비수궤대조실험P=0.696),량조지간복발솔무통계학차이(P=0.108),량조간생존무통계학차이(회총P=0.676,Ⅱ、Ⅲ기위주자P=0.683).전강경수술적출혈량(P=0.000)급병발증(P=0.007)경소,차이구유통계학의의.각문헌수술시간차이교대,무법진행합병.결론 전강경폐협절제술용우치료비소세포폐암시시일충안전、유효적술식,즉편재진전기적비소세포폐암야시여차.
Objective Performed the present meta-analysis of the randomized and non-randomized comparative studies in an attempt to mainly evaluate the lymph node dissection and survival rate of complete-VATS lobectomy Methods Electronic searches were undertaken to obtain the needed eligible comparative studies (6 randomized and 6 non-randomized).Two reviewers independently appraised each study.Combine the data of reported lymph node dissection,survival rate,blood loss,complications and recurrence rate.Data of survival rate was picked up from the survival curve as HR.Results Operation time varied a lot and it could not be combined.There were no significant statistical differences between complete-VATS and thoractomy or assisted-VATS in terms of lymph node dissection(total P =0.599,one subgroup P =0.243 and the other P =0.144,RCT P =0.977,RNT P =0.696),recurrence rate (P =0.108),survival rate(total P =0.676,no-stage Ⅰ lung cancer P =0.683).Complete-VATS had less blood loss (P =0.000) and less complications (P =0.007).There was no evidence to suggest heterogeneity of trial results.Conclusion Both randomized and nonrandomized trials suggest that complete-VATS might be a safe and reliable therapy in patients with NSCLC,even the ones in progress.