胸腔镜与开胸手术治疗胸部创伤疗效比较的Meta分析

摘要

Objective To compare the clinical effect of video-assisted thoracoscopic surgery with open thoracotomy for treatment of thoracic trauma. Methods Literature search was conducted in Pubmed, EMBASE, Cochrane Library, CNKI, VIP and WanFang database. Cochrane Collaboration's risk of bias assessment tool was used to assess the quality of the included studies. Meta-analysis was performed using RevMan 5.3 software. Results A total of 27 studies with 2210 patients were included. The mortality rate between thoracoscopic surgery group and open thoracotomy group was not significantly different (RR=0.82 (95%CI:0.24–2.79, P=0.75). The incidence of postoperative complications (RR=0.47 (95%CI: 0.33–0.65), P<0.001), amount of bleeding [MD= –100.39 mL (95%CI: –103.06 to –97.72), P<0.001], operation time [MD= –15.56 min (95%CI: –16.60 to –14.56), P<0.001], tube drainage volume [MD= –150.19 mL (95%CI: –188.71 to–111.67), P<0.001], duration of tube drainage [MD= –1.64 d (95%CI: –1.75 to –1.52), P<0.001] and duration of hospitalization [MD= –4.61 d (95%CI: –5.23 to –3.99), P<0.001] of patients in the thoracoscopic surgery group were significantly reduced compared with those in open thoracotomy group. Conclusion Thoracoscopic surgery is a safe and effective treatment for thoracic trauma.%目的:比较胸腔镜与开胸手术治疗胸部创伤的临床疗效.方法:检索Pubmed、EMBASE、Cochrane Library、中国知网、维普数据库及万方数据库收集关于胸腔镜与开胸手术治疗胸部创伤疗效比较的随机对照研究.利用Cochrane系统评价员手册5.1版偏倚风险评估标准进对研究质量进行评价,使用RevMan 5.3软件进行统计分析.结果:共纳入研究27项,患者2210例.Meta分析显示胸腔镜组患者术后的并发症发生率显著低于开胸手术组(RR值0.47(95%CI:0.33–0.65), P<0.001),且两组患者术后死亡率无明显差异[RR值0.82(95 %CI:0.24–2.79),P=0.75].胸腔镜组患者术中出血量[合并MD值–100.39 mL(95%CI:–103.06至–97.72),P<0.001]、手术时间[合并MD值为–15.56 min (95%CI:–16.60至–14.56),P<0.001]、术后引流量[合并MD值–150.19 mL(95%CI:–188.71至–111.67),P<0.001]、术后置管引流时间[合并MD值–1.64 d(95%CI:–1.75至–1.52), P<0.001]及住院时间[合并MD值–4.61 d (95%CI:–5.23至–3.99), P<0.001]均显著低于传统开胸手术组患者.结论:胸腔镜是一种安全有效的治疗胸部创伤的手段.