术前肺结节定位的有效性和安全性比较：系统评价和荟萃分析。
Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules: A Systematic Review and Meta-analysis.
机构信息
Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
出版信息
Chest. 2017 Feb;151(2):316-328. doi: 10.1016/j.chest.2016.09.017. Epub 2016 Oct 4.
BACKGROUND
An optimal method of preoperative localization for pulmonary nodules has yet to be established. This systematic review and meta-analysis aimed to compare the success and complication rates associated with three pulmonary nodule localization methods for video-assisted thoracoscopic surgery (VATS): hook-wire localization, microcoil localization, and lipiodol localization.
METHODS
We searched the PubMed, MEDLINE, and EMBASE databases for prospective or retrospective English language studies of VATS localization in adult patients. A noncomparative, random effects model-based meta-analysis was performed to obtain pooled success and complication rates for the three localization methods.
RESULTS
A total of 46 clinical studies were enrolled, including 30, 9, and 7 studies of hook-wire, microcoil, and lipiodol localization, respectively. The successful targeting rates for hook-wire, microcoil, and lipiodol localization were 0.98 (95% CI, 0.97-0.99), 0.98 (95% CI, 0.96-0.99), and 0.99 (95% CI, 0.98-1.00), respectively, with corresponding successful operative field targeting rates of 0.94 (95% CI, 0.91-0.96), 0.97 (95% CI, 0.95-0.98), and 0.99 (95% CI, 0.98-1.00), respectively. In addition, the successful VATS rates with hook-wire, microcoil, and lipiodol localization were 0.96 (95% CI, 0.94-0.97), 0.97 (95% CI, 0.94-0.99), and 0.99 (95% CI, 0.98-1.00), respectively. Regarding complications, hook-wire, microcoil, and lipiodol localization were associated with pneumothorax rates of 0.35 (95% CI, 0.28-0.43), 0.16 (95% CI, 0.07-0.34), and 0.31 (95% CI, 0.20-0.46), respectively and hemorrhage rates of 0.16 (95% CI, 0.11-0.23), 0.06 (95% CI, 0.03-0.11), and 0.12 (95% CI, 0.05-0.23), respectively.
CONCLUSIONS
All three localization methods yielded similarly highly successful targeting rates. However, hook-wire localization had a relatively lower successful operative field targeting rate because of dislodgement or migration. Lipiodol localization had the highest overall success rate, and microcoil localization yielded the lowest complication rates.
背景
对于肺结节，仍未建立最佳的术前定位方法。本系统评价和荟萃分析旨在比较三种用于电视辅助胸腔镜手术（VATS）的肺结节定位方法（钩wire 定位、微线圈定位和碘油定位）的成功率和并发症发生率。
方法
我们检索了 PubMed、MEDLINE 和 EMBASE 数据库中关于成人 VATS 定位的前瞻性或回顾性英文研究。采用非比较、随机效应模型的荟萃分析，获得三种定位方法的汇总成功率和并发症发生率。
结果
共纳入 46 项临床研究，分别为钩wire、微线圈和碘油定位的 30、9 和 7 项研究。钩 wire、微线圈和碘油定位的靶向成功率分别为 0.98（95%CI，0.97-0.99）、0.98（95%CI，0.96-0.99）和 0.99（95%CI，0.98-1.00），相应的手术视野靶向成功率分别为 0.94（95%CI，0.91-0.96）、0.97（95%CI，0.95-0.98）和 0.99（95%CI，0.98-1.00）。此外，钩 wire、微线圈和碘油定位的 VATS 成功率分别为 0.96（95%CI，0.94-0.97）、0.97（95%CI，0.94-0.99）和 0.99（95%CI，0.98-1.00）。关于并发症，钩 wire、微线圈和碘油定位的气胸发生率分别为 0.35（95%CI，0.28-0.43）、0.16（95%CI，0.07-0.34）和 0.31（95%CI，0.20-0.46），出血发生率分别为 0.16（95%CI，0.11-0.23）、0.06（95%CI，0.03-0.11）和 0.12（95%CI，0.05-0.23）。
结论
三种定位方法的靶向成功率均非常高。然而，由于钩 wire 定位的移位或迁移，其手术视野靶向成功率相对较低。碘油定位的总体成功率最高，微线圈定位的并发症发生率最低。
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