Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China.
World J Surg Oncol. 2020 Jan 4;18(1):5. doi: 10.1186/s12957-019-1777-3.
The necessity of the inferior pulmonary ligament (IPL) dissection after an upper lobectomy remains controversial. This meta-analysis aimed to evaluate whether this accessional procedure could reduce the postoperative complications and improve outcomes.
PubMed, Embase, Ovid, Cochrane Library, CBM, and CNKI databases were searched for the relevant studies which compared the dissection with preservation of IPL during the upper lobectomy. The Review Manager 5.3 software was used for this meta-analysis.
Three RCTs and five CCTs were included in this meta-analysis. These studies contained a total of 610 patients, in which 315 patients received a pulmonary ligament dissection (group D) after the upper lobectomy, while the other 295 patients preserved the pulmonary ligament (group P). No significant difference was demonstrated between the group D and group P in terms of drainage time after surgery (MD 0.14, 95%CI - 0.05 to 0.33, P = 0.15), rate of postoperative dead space (OR 1.33, 95%CI 0.72 to 2.46, P = 0.36), rate of postoperative complications (OR 1.20, 95%CI 0.66 to 2.19, P = 0.56). However, the pooled comparison revealed a greater change of the right main bronchial angle (MD 5.00, 95%CI 1.68 to 8.33, P = 0.003) in group D compared with group P, indicated that the dissection of IPL may lead to a greater distortion of bronchus.
This meta-analysis confirmed that the dissection of IPL do not effectively reduce the postoperative complications and improve the prognosis. Therefore, it is not necessary to dissect the IPL after an upper lobectomy.
上肺叶切除术后是否需要解剖下肺韧带（IPL）仍然存在争议。本荟萃分析旨在评估该附加手术是否能减少术后并发症并改善预后。
检索 PubMed、Embase、Ovid、Cochrane 图书馆、CBM 和中国知网数据库，以比较上肺叶切除术中解剖与保留 IPL 的相关研究。使用 Review Manager 5.3 软件进行荟萃分析。
本荟萃分析纳入了 3 项 RCT 和 5 项 CCT。这些研究共纳入 610 例患者，其中 315 例在上肺叶切除术后行肺韧带解剖（D 组），295 例保留肺韧带（P 组）。D 组和 P 组术后引流时间（MD 0.14，95%CI-0.05 至 0.33，P=0.15）、术后残腔发生率（OR 1.33，95%CI 0.72 至 2.46，P=0.36）、术后并发症发生率（OR 1.20，95%CI 0.66 至 2.19，P=0.56）差异均无统计学意义。然而，汇总比较显示 D 组与 P 组相比，右主支气管角的变化更大（MD 5.00，95%CI 1.68 至 8.33，P=0.003），表明 IPL 的解剖可能导致支气管更大的扭曲。
本荟萃分析证实，解剖 IPL 并不能有效减少术后并发症并改善预后。因此，在上肺叶切除术后无需解剖 IPL。
