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目的非小细胞肺癌(综合分期Ⅰ、Ⅱ期)在电视胸腔镜(VATS)下行肺叶切除术的临床疗效与传统开胸(OPEN)比较分析。方法按照Cochrane系统评价制作方法,收集所有倾向值匹配研究的病例对照试验,研究内容包括围手术期死亡率、复发率、术后并发症等,采用RevMan5.0软件进行Meta分析。结果共纳入11篇病例对照试验,共4040例患者,Meta分析表明:VATS能明显降低术后肺部(P<0.0001,OR=0.67,95%CI:0.55~0.81)和全身(P<0.00001,OR=0.66,95%CI:0.57~0.76)并发症的发生率、减少肿瘤复发率(P<0.00001,OR=0.62,95%CI:0.53~0.71)、对总死亡率(P=0.32,OR=0.78,95%CI:0.47~1.27)与开胸术相比没有优势。结论针对非小细胞肺癌(综合分期Ⅰ、Ⅱ期),与传统开胸术相比,VATS能明显减少肺部及全身并发症的发生率、降低肿瘤复发率,但总死亡率相比没有优势。
Objective To compare the clinical curative effect of conventional lobectomy between VATS and conventional open-chest surgery (OPEN) in patients with non-small cell lung cancer (stage Ⅰ and stage Ⅱ). Methods According to the method of Cochrane Systematic Review, a case-control study of all propensity matching studies was collected. The study included perioperative mortality, recurrence rate and postoperative complications. Meta-analysis was performed using RevMan 5.0 software. Results A total of 11 case-control trials were conducted in 4040 patients. Meta-analysis showed that VATS significantly reduced postoperative pulmonary function (P <0.0001, OR = 0.67, 95% CI: 0.55-0.81) OR = 0.66,95% CI: 0.57-0.76), and the rate of tumor recurrence was decreased (P 0. 00001, OR 0.62, 95% CI 0.53-0.71) = 0.78, 95% CI: 0.47 to 1.27) had no advantage over thoracotomy. Conclusion Compared with conventional thoracotomy, VATS can significantly reduce the incidence of pulmonary and systemic complications and reduce the recurrence rate of non-small cell lung cancer (stage Ⅰ, Ⅱ), but there is no advantage in total mortality .