上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (7): 997-.doi: 10.3969/j.issn.1674-8115.2017.07.020

• 论著（临床研究） • 上一篇    下一篇

电视辅助胸腔镜与常规切口肺减容术治疗重度慢性阻塞性  肺疾病效果比较的 meta 分析#br#

茅怡铭 1，魏长江 1，吴长江 2，秦元 1，陆佳昊 1，陆文强 1   

  1. 上海交通大学 医学院附属苏州九龙医院 1. 胸外科，2. 重症医学科，苏州  215000
  • 出版日期:2017-07-28 发布日期:2017-08-25
  • 作者简介:?茅怡铭（1985—），男，硕士，主治医师；电子信箱：253992240@qq.com

Comparison of efficacy of video-assisted thoracic surgery and conventional lung volume reduction surgery for the treatment of patients with severe chronic obstructive pulmonary disease: a meta-analysis

MAO Yi-ming1, WEI Chang-jiang1, WU Chang-jiang2, QIN Yuan1, LU Jia-hao1, LU Wen-qiang1   

  1. 1. Department of Thoracic Surgery, 2. Department of Intensive Care Unit,  Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215000,  China
  • Online:2017-07-28 Published:2017-08-25

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摘要：  目的 · 应用 meta 分析比较电视辅助胸腔镜（VATS）肺减容术与常规切口肺减容术治疗重度慢性阻塞性肺疾病患者的效果。 方法 · 计算机检索 Web of Science、EMbase、PubMed、the Cochrane Library、中国学术期刊全文数据库、中国生物医学文献数据光 盘数据库、万方数据库、维普数据库等，收集关于 VATS 肺减容术（VATS 组）与常规切口肺减容术（开胸组）治疗重度慢性阻塞性 肺疾病的随机对照试验及非随机对照研究。文献检索时间均从建库至 2016 年 11 月。评价纳入文献的质量并提取资料。采用 RevMan 5.3 统计软件进行 meta 分析。结果 · 检出相关文献 779 篇，根据纳入标准最终入选 12 篇，共 966 例患者。Meta 分析结果显示：在手 术时间方面，VATS 组中行双侧肺减容术的手术时间大于常规切口组，行单侧肺减容术的手术时间与开胸组的差异无统计学意义。在 胸管留置时间方面，VATS 组中行双侧肺减容术的胸管留置时间与开胸组的差异无统计学意义，行单侧肺减容术的胸管留置时间明 显少于开胸组。与开胸组比较，VATS 组术中出血量及术后胸腔引流量显著减少。在术后肺功能及血气分析方面，VATS 组的术后 6 min 步行距离大于开胸组，2 组在第一秒用力呼气量、动脉血氧分压及术后并发症发生率方面的差异无统计学意义。结论 · 相比于常 规切口肺减容术，VATS 肺减容术是更好的选择。因研究质量和研究样本的局限性，该结论仍有待设计严谨的大样本随机对照试验加 以验证。

关键词: 肺减容术, 慢性阻塞性肺疾病, 胸腔镜, meta 分析, 随机对照试验

Abstract:

Objective · To compare the efficacy of video-assisted thoracic surgery (VATS) and conventional lung volume reduction surgery for the treatment of patients with severe chronic obstructive pulmonary disease with a meta-analysis.  Methods ·  Randomized controlled trials (RCT) and nonrandomized control studies of VATS (the VATS group) and conventional lung volume reduction surgery (the thoracotomy group) for treating patients with severe chronic obstructive pulmonary disease were collected from databases, including Web of Science, EMbase, PubMed, the Cochrane Library, CNKI, CBM disc, WanFang Data, and VIP. The latest literature was published in November 2016. The assessment included the quality of literature and RevMan5.3 software was used to perform the meta-analysis.  Results · Of 779 retrieved articles, 12 studies involving 966 patients were included according to the inclusion criteria. The results of meta-analysis showed that the operation time of bilateral LVRS was longer in the VATS group than in the thoracotomy group, but the difference in the operation time of single LVRS between the two groups was not statistically significant. The difference in the duration of chest tube drainage for bilateral LVRS between the two groups was not statistically significant, while the duration of chest tube drainage for single LVRS was significantly shorter in the VATS group than in the thoracotomy group. The amount of intraoperative blood loss postoperative drainage was significantly smaller in the VATS group than in the thoracotomy group. Postoperative pulmonary function and blood gas analysis showed that the 6 min walking distance was longer in the VATS group than in the thoracotomy group. The differences in FEV1 and PaO2 between the two groups were not statistically significant, as well as the difference in postoperative complications between the two groups.  Conclusion · Comparing to conventional lung volume reduction surgery, Video-Assisted thoracic lung volume reduction surgery is a better choice. However, randomized control trials with higher quality and larger scale are required for verification this conclusion due to limitations of the quality and samples of these studies.

Key words: lung volume reduction, chronic obstructive pulmonary disease, video-assisted thoracic surgery, meta-analysis, randomized controlled trials