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

发布时间：2018-02-02 14:10

本文关键词： 肺减容术慢性阻塞性肺疾病胸腔镜 meta分析随机对照试验　出处：《上海交通大学学报(医学版)》2017年07期 　论文类型：期刊论文

【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RevMan5.3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6min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。
[Abstract]:Objective: to compare VATS with video-assisted thoracoscopy by meta analysis. Effect of lung volume reduction and conventional incision lung volume reduction on patients with severe chronic obstructive pulmonary disease. Methods Web of Science was searched by computer. Cochrane Library, full text Database of Chinese academic Journals, CD-ROM Database of Chinese Biomedical Literature data, Wanfang Database. Wiper, database, etc. Collect information on VATS lung volume reduction and conventional incision lung volume reduction (thoracotomy group). A randomized controlled trial and a non-randomized controlled trial for the treatment of severe chronic obstructive pulmonary disease. The retrieval time of the literature was from the establishment of the database to November 2016. The quality of the literature was evaluated and the data were extracted by RevMa. Meta analysis was carried out with statistical software N5.3. Results 779 papers were found. A total of 966 patients. Meta-analysis showed that bilateral lung volume reduction in vats group was longer than that in conventional incision group. There was no significant difference between the operation time of unilateral lung volume reduction and that of thoracotomy group. There was no significant difference between bilateral lung volume reduction group and thoracotomy group in the time of chest tube indwelling. Compared with the thoracotomy group, the volume of intraoperative bleeding and postoperative thoracic drainage volume in vats group were significantly reduced, and the postoperative lung function and blood gas analysis. The walking distance 6 minutes after operation in VATS group was longer than that in open chest group and forced expiratory volume at 1 second in group 2. There was no significant difference in arterial partial pressure of oxygen and incidence of postoperative complications. Conclusion: compared with conventional incision lung volume reduction. VATS lung volume reduction is a better choice. Due to the quality of the study and the limitations of the study samples, this conclusion has yet to be verified by a well-designed randomized controlled trial of large samples.
【作者单位】：上海交通大学医学院附属苏州九龙医院胸外科;上海交通大学医学院附属苏州九龙医院重症医学科;
【分类号】：R655.3
【正文快照】： 慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种以不可逆性气流受限为主要特征的进行性、慢性气道炎性疾病[1],是未来危害人类健康的主要疾病[2]。当COPD发展到中重度后,单纯药物治疗效果不理想[3]。美国肺气肿治疗试验(National Emphysema Treatment T

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