Zhang Kai, Chen Hui-Guo, Wu Wei-Bin, Li Xiao-Jun, Wu Yong-Hui, Xu Jian-Nan, Jia Yu-Bin, Zhang Jian
Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China.
J Thorac Dis. 2019 Aug;11(8):3556-3568. doi: 10.21037/jtd.2019.07.48.
Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly used in lobectomy, bullectomy, wedge resection, lung volume reduction, sympathectomy and talc pleurodesis, which may reduce postoperative complications. However, the benefits of non-intubated and intubated methods of VATS remain controversial.
We comprehensively searched PubMed, Web of Science, Embase and the Cochrane Library, and performed a systematic review to assess the two techniques. Random and fixed-effects meta-analytical models were used based on the low between-study heterogeneity. Study quality, publication bias, and heterogeneity were assessed.
Compared to intubated methods, NIVATS had a lower postoperative complications rate [odds ratio (OR): 0.63; 95% confidence interval (CI), 0.46-0.86; P<0.01], shorter global in-operating time [weighted mean difference (WMD): -35.96 min; 95% CI, -48.00 to -23.91; P<0.01], shorter hospital stay (WMD: -1.35 days; 95% CI, -1.72 to -0.98; P<0.01), shorter anesthesia time (WMD: -7.29 min; 95% CI, -13.30 to -1.29; P<0.01), shorter chest-tube placement time (WMD: -1.04 days; 95% CI, -1.75 to -0.33; P<0.01), less chest pain (WMD: -1.31; 95% CI, -2.45 to -0.17; P<0.05) and lower perioperative mortality rate (OR: 0.13; 95% CI, 0.02-0.99; P=0.05).
NIVATS is a safe, efficient and feasible technique for thoracic surgery and may be a better alternative procedure owing to its advantage in reducing postoperative complications rate, hospital stay, and chest pain.
非插管电视辅助胸腔镜手术（NIVATS）已越来越多地应用于肺叶切除术、肺大疱切除术、楔形切除术、肺减容术、交感神经切除术和滑石粉胸膜固定术，这可能会减少术后并发症。然而，VATS的非插管和插管方法的益处仍存在争议。
我们全面检索了PubMed、科学网、Embase和Cochrane图书馆，并进行了系统评价以评估这两种技术。基于研究间低异质性，使用随机和固定效应荟萃分析模型。评估研究质量、发表偏倚和异质性。
与插管方法相比，NIVATS术后并发症发生率较低[比值比（OR）：0.63；95%置信区间（CI），0.46 - 0.86；P < 0.01]，总手术时间较短[加权平均差（WMD）：-35.96分钟；95% CI，-48.00至-23.91；P < 0.01]，住院时间较短（WMD：-1.35天；95% CI，-1.72至-0.98；P < 0.01），麻醉时间较短（WMD：-7.29分钟；95% CI，-13.30至-1.29；P < 0.01），胸管放置时间较短（WMD：-1.04天；95% CI，-1.75至-0.33；P < 0.01），胸痛较轻（WMD：-1.31；95% CI，-2.45至-0.17；P < 0.05），围手术期死亡率较低（OR：0.13；95% CI，0.02 - 0.99；P = 0.05）。
NIVATS是一种安全、有效且可行的胸外科手术技术，由于其在降低术后并发症发生率、住院时间和胸痛方面的优势，可能是一种更好的替代手术方法。
