Luo Yuxiang, He Feng, Wu Qingchen, Shi Haoming, Chen Dan, Tie Hongtao
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Cardiothoracic Surgery, Fifth People's Hospital of Chongqing, Chongqing, China.
Front Surg. 2022 May 6;9:900414. doi: 10.3389/fsurg.2022.900414. eCollection 2022.
Accumulating researches show potential advantages of video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach, and this meta-analysis aims to investigate the efficacy and safety of the subxiphoid approach for anterior mediastinal surgery.
Relevant studies were retrieved by searching Embase and PubMed databases (from the inception to October 1, 2021). Primary outcomes included postoperative pain, intraoperative blood loss, operation time, chest tube duration, and hospital length of stay. All meta-analyses were performed by using random-effects models.
Overall, 14 studies with 1,279 patients were included, with 504 patients undergoing anterior mediastinal surgery via subxiphoid approach and 775 via other approaches. The pooled results indicated that the subxiphoid approach was associated with reduced postoperative pain indicated by visual analog scale [weight mean difference (WMD): 24 h: -2.27, 95% CI, -2.88 to -1.65, < 0.001; 48-72 h: -1.87, 95% CI, -2.53 to -1.20, < 0.001; 7 days: -0.98, 95% CI, -1.35 to -0.61, < 0.001], shortened duration of chest tube drainage (WMD: -0.56 days, 95% CI, -0.82 to -0.29, < 0.001), shortened hospital length of stay (WMD: -1.46 days, 95% CI, -2.28 to -0.64, < 0.001), and reduced intraoperative blood loss (WMD: -26.44 mL, 95% CI, -40.21 to -12.66, < 0.001) by comparison with other approaches in anterior mediastinal surgery. Besides, it has no impact on operation time and the incidence of complications of transition to thoracotomy, postoperative pleural effusion, phrenic nerve palsy, and lung infection.
Our study suggests that the subxiphoid approach is a feasible alternative approach and even can be a better option for anterior mediastinal surgery. Further, large-scale multicenter randomized controlled trials are needed to validate this finding.
越来越多的研究显示了经剑突下入路的电视辅助胸腔镜手术（VATS）的潜在优势，本荟萃分析旨在探讨剑突下入路在前纵隔手术中的疗效和安全性。
通过检索Embase和PubMed数据库（从数据库建立至2021年10月1日）获取相关研究。主要结局包括术后疼痛、术中失血、手术时间、胸管留置时间和住院时间。所有荟萃分析均采用随机效应模型进行。
总体而言，纳入了14项研究，共1279例患者，其中504例患者经剑突下入路行前纵隔手术，775例经其他入路。汇总结果表明，与前纵隔手术的其他入路相比，剑突下入路术后疼痛减轻，视觉模拟评分显示：[加权均值差（WMD）：24小时：-2.27，95%置信区间（CI），-2.88至-1.65，P＜0.001；48 - 72小时：-1.87，95%CI，-2.53至-1.20，P＜0.001；7天：-0.98，95%CI，-1.35至-0.61，P＜0.001]，胸管引流时间缩短（WMD：-0.56天，95%CI，-0.82至-0.29，P＜0.001），住院时间缩短（WMD：-1.46天，95%CI，-2.28至-0.64，P＜0.001），术中失血减少（WMD：-26.44 mL，95%CI，-40.21至-12.66，P＜0.001）。此外，它对手术时间以及中转开胸、术后胸腔积液、膈神经麻痹和肺部感染等并发症的发生率没有影响。
我们的研究表明，剑突下入路是一种可行的替代入路，甚至可能是前纵隔手术的更好选择。此外，需要大规模多中心随机对照试验来验证这一发现。
