Zhang X, Yu Q, Lv D
Department of Thoracic Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian 116023, China.
Indian J Cancer. 2017 Jan-Mar;54(1):291-300. doi: 10.4103/ijc.IJC_229_17.
We conducted this meta-analysis to compare the clinical outcomes of single-incision and multiple-incision video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer patients.
A literature search was conducted of the Cochrane Controlled Trials Register Databases, Medline, EMBASE, Web of Science databases, and Chinese Biomedical Literature Database. Eleven studies that compared single-incision VATS with multiple-incision VATS in the treatment of lung cancer were analyzed. Statistical analysis was carried out using RevMan 5.1 software.
Eleven trials totaling 1273 patients were included. There were statistically significant differences in the duration of chest tube (standardized mean difference [SMD] = -0.42; 95% confidence interval [CI] [-0.78, -0.07], P < 0.02), hospital stays after surgery (SMD = -0.28; 95% CI [-0.41, -0.15], P < 0.0001), hospital stays after surgery in the subgroup analysis of lobectomy (SMD = -0.28; 95% CI [-0.42, -0.14], P < 0.0001), length of wound (P < 0.05), and pain visual analog scale (VAS) in the postoperative 1 day (SMD = -1.19; 95% CI [-1.94, -0.44], P = 0.002) between single-incision VATS group and multiple-incision VATS group. Compared with patients receiving multiple-incision VATS group, there were no statistically significant differences between the two groups with regard to the operative time (OT), blood loss (BL), rate of conversion to thoracotomy, and complication.
Compared with multiple-incision VATS on the condition of same lymph nodes retrieved number, single-incision VATS reduced the length of wound, shortened the duration of chest tube, cut down the hospital stays after surgery, alleviated the pain VAS in the postoperative 1 day, did not significantly increase the OT and the BL in operation, and did not increase the rate of conversion to thoracotomy and complication.
我们进行这项荟萃分析，以比较单切口与多切口电视辅助胸腔镜手术（VATS）肺叶切除术治疗肺癌患者的临床结局。
检索Cochrane对照试验注册数据库、Medline、EMBASE、Web of Science数据库和中国生物医学文献数据库。分析了11项比较单切口VATS与多切口VATS治疗肺癌的研究。使用RevMan 5.1软件进行统计分析。
纳入11项试验，共1273例患者。单切口VATS组与多切口VATS组在胸管留置时间（标准化均数差[SMD]=-0.42；95%置信区间[CI][-0.78，-0.07]，P<0.02）、术后住院时间（SMD=-0.28；95%CI[-0.41，-0.15]，P<0.0001）、肺叶切除亚组分析中的术后住院时间（SMD=-0.28；95%CI[-0.42，-0.14]，P<0.0001）、伤口长度（P<0.05）以及术后1天疼痛视觉模拟量表（VAS）（SMD=-1.19；95%CI[-1.94，-0.44]，P=0.002）方面存在统计学显著差异。与接受多切口VATS组的患者相比，两组在手术时间（OT）、失血量（BL）、开胸转换率和并发症方面无统计学显著差异。
在相同淋巴结清扫数量的情况下，与多切口VATS相比，单切口VATS缩短了伤口长度，缩短了胸管留置时间，减少了术后住院时间，减轻了术后1天的疼痛VAS，手术中的OT和BL没有显著增加，开胸转换率和并发症也没有增加。
