摘要
目的系统评价胸腔镜手术与传统开胸手术比较治疗胸腺瘤的疗效。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年3期)、Web of Science、CBM、Wan Fang Data和CNKI数据库,搜集关于胸腔镜手术与传统开胸手术治疗胸腺瘤的随机对照试验(RCT)和队列研究,检索时限均从建库至2016年4月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行分析。结果最终纳入5个RCT和8个队列研究,包括1 093例患者。Meta分析结果显示:与传统开胸手术相比,胸腔镜手术能缩短手术时间[MD=–22.2,95%CI(–31.92,–12.52),P<0.000 01]、入住ICU时间[MD=–0.76,95%CI(–1.21,–0.30),P<0.000 01]、住院时间[MD=–3.71,95%CI(–4.47,–2.96),P<0.000 01]、胸管引流时间[MD=–1.80,95%CI(–2.42,–1.18),P<0.000 01],减少术中出血量[MD=–43.27,95%CI(–50.94,–35.60),P<0.000 01],并降低术后并发症的发生率[OR=0.19,95%CI(0.11,0.34),P<0.000 01];但在肿瘤复发率方面,两组差异无统计学意义[OR=0.81,95%CI(0.31,2.11),P=0.67]。结论现有证据表明,与开胸手术相比,胸腔镜手术治疗胸腺瘤的手术时间、入住ICU时间、住院时间和胸管引流时间更短,术中出血量更少且术后并发症发生率更低。但受纳入研究质量的限制,上述结论尚需开展更多高质量的研究予以验证。
Objective To systematically review the effectiveness of thoracoscopy surgery and thoracotomy for thymoma. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 3, 2016）, Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials （RCTs） and cohort studies about thoracoscopy surgery versus thoracotomy for thymoma from inception to April 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs and 8 cohort studies involving 1 093 patients were included. The results of meta-analysis showed that, compared with thoracotomy, the thoracoscopy surgery could shorten operative time （MD= -22.2, 95%CI -32.92 to -12.52, P〈0.000 01）, duration of ICU stay （MD= -0.76, 95%CI -0.21 to -0.30, P〈0.000 01）, duration of hospital stay （MD= -3.71, 95%CI -4.47 to -2.96, P〈0.000 01） and duration of pleural drainage （MD= -1.80, 95%CI -2.42 to -1.18, P〈0.000 01）, reduce volume of intraoperative blood loss （MD= -43.27, 95%CI -50.94 to -35.60, P〈0.000 01）, and decrease the incidence of postoperative complications （OR=0.19, 95%CI 0.11 to 0.34, P〈0.000 01）, but there was no significant difference in recurrence rate between two groups （OR=0.81, 95%CI 0.31 to 2.11, P=0.67）. Conclusions Current evidence shows that, compared with thoracotomy, the thoracoscopy surgery for thymoma has shorter operative time, duration of ICU stay, duration of hospital stay, and duration of pleural drainage, as well as less blood loss and postoperative complications. Due to the limited quality of included studies, more high-quality studies are needed to verify the above conclusion.
出处
《中国循证医学杂志》
CSCD
2016年第6期689-697,共9页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金(编号:096RJZA080)
甘肃省自然科学基金(编号:1208RJZA137)
