肺包虫病中电视辅助胸腔镜手术与开胸手术的比较结果：一项系统评价和荟萃分析
Comparative outcomes video-assisted thoracic surgery versus open thoracic surgery in pulmonary echinococcosis: a systematic review and meta-analysis.
作者信息
Salvador Isabella Cabianca Moriguchi Caetano, da Nobrega Oliveira Rachid Eduardo Noleto, de Almeida Silva Ingryd, Torres Lucas Antônio Fernandes, Camarotti Maria Tereza, Passos Felipe Santos, Mariani Alessandro Wasum
机构信息
University Anhembi Morumbi, Street Francisca Júlia, 563, North Zone, São Paulo, SP, 2403-011, Brazil.
Department of Thoracic Surgery, Barretos Cancer Hospital, Barretos, Brazil.
出版信息
Gen Thorac Cardiovasc Surg. 2025 Mar 18. doi: 10.1007/s11748-025-02138-x.
AIM
This meta-analysis aimed to evaluate and compare the outcomes of video-assisted thoracic surgery (VATS) and open thoracic surgery (OT) in the management of pulmonary echinococcosis.
METHODS
We conducted a comprehensive search of PubMed, Embase, and Cochrane databases for studies comparing VATS and OT. Odds ratios (ORs) for binary outcomes and mean differences (MDs) for continuous variables were calculated with 95% confidence intervals (CIs) using the DerSimonian and Laird random-effects model. Heterogeneity was assessed using I statistics.
RESULTS
Seven studies involving 2292 patients were included. VATS demonstrated significant advantages over OT, with reductions in intraoperative blood loss (MD - 81.65 mL, 95% CI - 129.90 to - 33.40), duration of thoracic drainage (MD - 2.29 days, 95% CI - 3.61 to - 0.98), operative time (MD - 45.73 min, 95% CI - 68.41 to - 23.05), narcotic use (MD -3.98 days, 95% CI - 6.21 to - 1.75), length of hospital stay (MD - 3.66 days, 95% CI - 5.66 to - 1.67), postoperative drainage volume (MD - 124.77 mL, 95% CI - 206.27 to - 43.27), and visual analogic score pain at 24 h after surgery (MD - 2.05 points, 95% CI - 2.40 to - 1.70). However, VATS was associated with a higher incidence of atelectasis (OR 3.27, 95% CI 1.03-10.35). No significant differences were observed in other complications, such as bronchopulmonary fistula, surgical wound infection, prolonged air leak, or failure of lung expansion.
CONCLUSIONS
VATS was associated with perioperative benefits, including reduced recovery times and resource utilization. Nonetheless, the higher risk of atelectasis suggests OT may remain favorable in complex cases requiring broader surgical access. Tailoring the surgical approach to the patient's needs remains crucial.
TRIAL REGISTRY
International Prospective Register of Systematic Reviews; Nº: CRD42025630187; URL: https://www.crd.york.ac.uk/prospero/ .
目的
本荟萃分析旨在评估和比较电视辅助胸腔镜手术（VATS）和开胸手术（OT）治疗肺包虫病的疗效。
方法
我们全面检索了PubMed、Embase和Cochrane数据库，以查找比较VATS和OT的研究。使用DerSimonian和Laird随机效应模型计算二分类结局的比值比（OR）和连续变量的平均差（MD），并给出95%置信区间（CI）。使用I统计量评估异质性。
结果
纳入了7项研究，共2292例患者。VATS相对于OT显示出显著优势，术中失血量减少（MD - 81.65 mL，95% CI - 129.90至 - 33.40）、胸腔引流时间缩短（MD - 2.29天，95% CI - 3.61至 - 0.98）、手术时间缩短（MD - 45.73分钟，95% CI - 68.41至 - 23.05）、麻醉药物使用时间缩短（MD -3.98天，95% CI - 6.21至 - 1.75）、住院时间缩短（MD - 3.66天，95% CI - 5.66至 - 1.67）、术后引流量减少（MD - 124.77 mL，95% CI - 206.27至 - 43.27）以及术后24小时视觉模拟评分疼痛减轻（MD - 2.05分，95% CI - 2.40至 - 1.70）。然而，VATS与肺不张发生率较高相关（OR 3.27，95% CI 1.03 - 10.35）。在其他并发症方面，如支气管肺瘘、手术切口感染、持续漏气或肺扩张不全，未观察到显著差异。
结论
VATS具有围手术期优势，包括恢复时间缩短和资源利用减少。尽管如此，肺不张风险较高表明，在需要更广泛手术入路的复杂病例中，OT可能仍然更具优势。根据患者需求定制手术方式仍然至关重要。
试验注册
国际系统评价前瞻性注册库；编号：CRD42025630187；网址：https://www.crd.york.ac.uk/prospero/ 。
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