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胸腔镜与开胸手术对肺癌患者术后伤口并发症的影响:一项荟萃分析。

Effect of thoracoscopic and thoracotomy on postoperative wound complications in patients with lung cancer: A meta-analysis.

机构信息

Department of Thoracic Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China.

Department of Interventional Oncology, Affiliated Hospital of Weifang Medical University, Weifang, China.

出版信息

Int Wound J. 2023 Dec;20(10):4217-4226. doi: 10.1111/iwj.14322. Epub 2023 Aug 18.

Abstract

Because of the difficult surgical procedures, patients with lung cancer who have received thoracic surgery tend to have postoperative complications. It may lead to postoperative complications like wound infection, wound haematoma and pneumothorax. A lot of research has assessed the effect of various surgery methods on postoperative complications in pulmonary cancer. The purpose of this meta-analysis is to establish if thoracoscopic is superior to that of thoracotomy in the rate of post-operative complications. From the beginning to the end of June 2023, we performed an exhaustive search on four main databases for key words. The Hazard of Bias in Non-Randomized Interventional Studies (ROBINS-I) was evaluated in the literature. In the end, 13 trials that fulfilled the eligibility criteria underwent further statistical analyses. The results showed that thoracoscopic intervention decreased the risk of post operative wound infection (dominant ratio [OR], 3.00; 95% confidence margin [CI], 1.98, 4.55; p < 0.00001) and air-leakage after operation (OR, 1.30; 95% CI, 1.04, 1.63; p = 0.02). There was no statistically significant difference between the two groups in terms of the rate of haemorrhage after operation (OR, 0.10; 95% CI, 0.73, 1.66; p = 0.63). Our findings indicate that thoracoscopic is less likely to cause post operative infection and gas leakage than thoracotomy, and it does not decrease the risk of postoperative haemorrhage. As some of the chosen trials are too small to conduct meta-analyses, care must be taken when handling the data. In the future, a large number of randomized, controlled trials will be required to provide additional evidence for this research.

摘要

由于手术过程复杂,接受过胸部手术的肺癌患者往往会出现术后并发症。这可能导致术后并发症,如伤口感染、伤口血肿和气胸。许多研究评估了各种手术方法对肺癌术后并发症的影响。本荟萃分析的目的是确定胸腔镜手术是否优于开胸手术,以降低术后并发症的发生率。从 2023 年 6 月底开始,我们在四个主要数据库中对关键词进行了全面搜索。使用非随机干预研究中的偏倚风险(ROBINS-I)评估文献中的偏倚风险。最终,有 13 项符合纳入标准的试验进行了进一步的统计分析。结果表明,胸腔镜干预降低了术后伤口感染(优势比[OR],3.00;95%置信区间[CI],1.98,4.55;p<0.00001)和术后漏气(OR,1.30;95% CI,1.04,1.63;p=0.02)的风险。两组术后出血率(OR,0.10;95% CI,0.73,1.66;p=0.63)无统计学差异。我们的研究结果表明,与开胸手术相比,胸腔镜手术不太可能引起术后感染和气体泄漏,也不会降低术后出血的风险。由于一些选择的试验太小,无法进行荟萃分析,在处理数据时必须小心。未来需要大量的随机对照试验为这项研究提供更多的证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2587/10681477/3e48738bc27c/IWJ-20-4217-g009.jpg

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