肺棘球蚴病视频辅助胸腔手术与开胸手术的疗效比较：系统综述和荟萃分析。

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

General Thoracic and Cardiovascular Surgery Pub Date : 2025-03-18 DOI:10.1007/s11748-025-02138-x

Isabella Cabianca Moriguchi Caetano Salvador, Rachid Eduardo Noleto da Nobrega Oliveira, Ingryd de Almeida Silva, Lucas Antônio Fernandes Torres, Maria Tereza Camarotti, Felipe Santos Passos, Alessandro Wasum Mariani

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引用次数: 0

摘要

目的：本荟萃分析旨在评价和比较视频辅助胸外科手术（VATS）和开放胸外科手术（OT）治疗肺棘球蚴病的疗效。方法：我们对PubMed、Embase和Cochrane数据库进行了全面的检索，以比较VATS和OT的研究。使用DerSimonian和Laird随机效应模型，以95%置信区间（ci）计算二元结果的优势比（ORs）和连续变量的平均差异（MDs）。采用I2统计量评估异质性。结果：纳入7项研究，共2292例患者。大桶证明显著的优势在OT,减少术中失血(MD - 81.65毫升,95% CI, 129.90 - 33.40),胸腔引流时间(MD - 2.29天,95% CI, 3.61 - 0.98),手术时间(MD - 45.73分钟,95% CI, 68.41 - 23.05),使用毒品(MD -3.98天,95% CI, 6.21 - 1.75),住院时间(MD - 3.66天,95% CI, 5.66 - 1.67),术后排水体积(MD - 124.77毫升,95% CI, 206.27 - 43.27),术后24 h疼痛视觉模拟评分（MD - 2.05分，95% CI - 2.40 ~ - 1.70）。然而，VATS与较高的肺不张发生率相关（OR 3.27, 95% CI 1.03-10.35）。其他并发症如支气管肺瘘、手术伤口感染、长时间漏气或肺扩张失败等方面无显著差异。结论：VATS与围手术期获益相关，包括减少恢复时间和资源利用率。尽管如此，较高的肺不张风险表明，对于需要更广泛手术通路的复杂病例，OT仍然是有利的。根据病人的需要调整手术方法仍然至关重要。试验注册：国际前瞻性系统评价注册；Nº:CRD42025630187;网址：https://www.crd.york.ac.uk/prospero/。

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Comparative outcomes video-assisted thoracic surgery versus open thoracic surgery in pulmonary echinococcosis: a systematic review and meta-analysis.

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 I² 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/ .

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来源期刊

General Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine

CiteScore

2.70

自引率

8.30%

发文量

142

期刊介绍： The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.