Ⅰ期非小细胞肺癌行胸腔镜下肺段切除与肺叶切除的meta分析

发布时间：2018-04-28 17:16

  本文选题：胸腔镜 + 肺段切除　； 参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:电视辅助胸腔镜手术(Video-assisted thoracic surgery,VATS)在治疗临床Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)中得到广泛的应用,但具体手术方式(解剖性肺叶切除或解剖性肺段切除)的选择存在争议。本文对胸腔镜下肺叶切除和肺段切除治疗临床Ⅰ期NSCLC的临床效果做一系统评价,以期对临床决策提供帮助。方法:在PubMed,Embase、Cochrane Library、万方数据库、中国知网数据库中,用关键词“lobectomy”、“segmentectomy”、“lung”、“cancer or tumor or neoplasm or carcinoma or NSCLC or non-small-cell lung”、“thoracoscopy or thoracic surgery or Video-assisted or VATS or thoracoscopic”或中文主关键词“肺段切除”、“肺叶切除”、“胸腔镜”、“肺癌”检索关于胸腔镜下肺段切除和肺叶切除治疗临床Ⅰ期NSCLC的对比研究,根据纳入及排除指标选择合适文献。利用Revman5.3处理数据。结果:共12篇回顾性对照研究,2058例患者纳入Meta分析。分析结果表明:在治疗临床Ⅰ期NSCLC,胸腔镜下肺段切除和肺叶切除在术后1年生存率(OR=0.95 95%CI:0.21~4.25,P=0.950.05),3年生存率(OR=1.36 95%CI:0.61~3.04,P=0.450.05),5年生存率(OR=0.87 95%CI:0.56~1.34,P=0.530.05),总复发率(OR=0.8095%CI:0.49~1.29,P=0.350.05),局部复发率(OR=1.02 95%CI:0.58~1.77,P=0.950.05)及并发症(OR=0.97 95%CI:0.67~1.39,P=0.860.05)上无明显统计学意义。亚组分析肿瘤直径≤3cm的Ia期NSCLC,上述各项亦无统计学意义。但是两种手术方式在治疗临床Ⅰ期NSCLC和直径≤3cm的Ia期NSCLC的术后住院时间上都有统计学意义(MD=-0.92 95%CI:-1.47~-0.36,P=0.0010.05;MD=-0.9195%CI:-1.64~0.19,P=0.010.05)。结论:VATS肺段切除术治疗临床Ia期甚至Ⅰ期NSCLC患者,都能取得较好的安全性和有效性。VATS解剖性肺段切除术在术后1、3、5年生存率,总复发率,局部复发率和并发症方面与VATS肺叶切除术效果相当,能为Ⅰ期NSCLC提供满意预后,且能缩短术后住院时间。胸腔镜下肺段切除术或许能成为治疗临床Ⅰ期NSCLC的又一选择。
[Abstract]:Objective: Video-assisted thoracic Surgeryus (VATS) has been widely used in the treatment of stage I non-small cell lung cancer (NSCLC), but the choice of specific surgical methods (anatomical lobectomy or anatomical segmentectomy) is controversial. The clinical effects of thoracoscopic lobectomy and segmental resection in the treatment of stage I NSCLC were systematically evaluated in order to provide help for clinical decision making. Methods: we used the keywords "lobectomy", "segmentectomy", "lung", "cancer or tumor or neoplasm or carcinoma or NSCLC or non-small-cell lung" in PubMedus Embase Cochrane Library, Wanfang Database and China knowledge Network Database. "thoracoscopy or thoracic surgery or Video-assisted or VATS or thoracoscopic" or "lung segmentectomy", "lobectomy", "thoracoscopy" and "lung cancer" were used to search for a comparative study on clinical stage I NSCLC treated by thoracoscopic segmental resection and lobectomy. Select appropriate documents according to inclusion and exclusion indicators. Use Revman5.3 to process data. Results: a total of 12 retrospective controlled studies involving 2058 patients were included in Meta analysis. 鍒嗘瀽缁撴灉琛ㄦ槑:鍦ㄦ不鐤椾复搴娾厾鏈烴SCLC,鑳歌厰闀滀笅鑲烘�靛垏闄ゅ拰鑲哄彾鍒囬櫎鍦ㄦ湳鍚�1骞寸敓瀛樼巼(OR=0.95 95%CI:0.21~4.25,P=0.950.05),3骞寸敓瀛樼巼(OR=1.36 95%CI:0.61~3.04,P=0.450.05),5骞寸敓瀛樼巼(OR=0.87 95%CI:0.56~1.34,P=0.530.05),鎬诲�嶅彂鐜�(OR=0.8095%CI:0.49~1.29,P=0.350.05),灞，

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