本文選題：胸腔鏡 + 肺段切除��； 參考：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：目的:電視輔助胸腔鏡手術(shù)(Video-assisted thoracic surgery,VATS)在治療臨床Ⅰ期非小細胞肺癌(non-small cell lung cancer,NSCLC)中得到廣泛的應(yīng)用,但具體手術(shù)方式(解剖性肺葉切除或解剖性肺段切除)的選擇存在爭議。本文對胸腔鏡下肺葉切除和肺段切除治療臨床Ⅰ期NSCLC的臨床效果做一系統(tǒng)評價,以期對臨床決策提供幫助。方法:在PubMed,Embase、Cochrane Library、萬方數(shù)據(jù)庫、中國知網(wǎng)數(shù)據(jù)庫中,用關(guān)鍵詞“l(fā)obectomy”、“segmentectomy”、“l(fā)ung”、“cancer or tumor or neoplasm or carcinoma or NSCLC or non-small-cell lung”、“thoracoscopy or thoracic surgery or Video-assisted or VATS or thoracoscopic”或中文主關(guān)鍵詞“肺段切除”、“肺葉切除”、“胸腔鏡”、“肺癌”檢索關(guān)于胸腔鏡下肺段切除和肺葉切除治療臨床Ⅰ期NSCLC的對比研究,根據(jù)納入及排除指標選擇合適文獻。利用Revman5.3處理數(shù)據(jù)。結(jié)果:共12篇回顧性對照研究,2058例患者納入Meta分析。分析結(jié)果表明:在治療臨床Ⅰ期NSCLC,胸腔鏡下肺段切除和肺葉切除在術(shù)后1年生存率(OR=0.95 95%CI:0.21~4.25,P=0.950.05),3年生存率(OR=1.36 95%CI:0.61~3.04,P=0.450.05),5年生存率(OR=0.87 95%CI:0.56~1.34,P=0.530.05),總復發(fā)率(OR=0.8095%CI:0.49~1.29,P=0.350.05),局部復發(fā)率(OR=1.02 95%CI:0.58~1.77,P=0.950.05)及并發(fā)癥(OR=0.97 95%CI:0.67~1.39,P=0.860.05)上無明顯統(tǒng)計學意義。亞組分析腫瘤直徑≤3cm的Ia期NSCLC,上述各項亦無統(tǒng)計學意義。但是兩種手術(shù)方式在治療臨床Ⅰ期NSCLC和直徑≤3cm的Ia期NSCLC的術(shù)后住院時間上都有統(tǒng)計學意義(MD=-0.92 95%CI:-1.47~-0.36,P=0.0010.05;MD=-0.9195%CI:-1.64~0.19,P=0.010.05)。結(jié)論:VATS肺段切除術(shù)治療臨床Ia期甚至Ⅰ期NSCLC患者,都能取得較好的安全性和有效性。VATS解剖性肺段切除術(shù)在術(shù)后1、3、5年生存率,總復發(fā)率,局部復發(fā)率和并發(fā)癥方面與VATS肺葉切除術(shù)效果相當,能為Ⅰ期NSCLC提供滿意預(yù)后,且能縮短術(shù)后住院時間。胸腔鏡下肺段切除術(shù)或許能成為治療臨床Ⅰ期NSCLC的又一選擇。
[Abstract]:Objective: Video-assisted thoracic Surgeryus (VATS) has been widely used in the treatment of stage I non-small cell lung cancer (NSCLC), but the choice of specific surgical methods (anatomical lobectomy or anatomical segmentectomy) is controversial. The clinical effects of thoracoscopic lobectomy and segmental resection in the treatment of stage I NSCLC were systematically evaluated in order to provide help for clinical decision making. Methods: we used the keywords "lobectomy", "segmentectomy", "lung", "cancer or tumor or neoplasm or carcinoma or NSCLC or non-small-cell lung" in PubMedus Embase Cochrane Library, Wanfang Database and China knowledge Network Database. "thoracoscopy or thoracic surgery or Video-assisted or VATS or thoracoscopic" or "lung segmentectomy", "lobectomy", "thoracoscopy" and "lung cancer" were used to search for a comparative study on clinical stage I NSCLC treated by thoracoscopic segmental resection and lobectomy. Select appropriate documents according to inclusion and exclusion indicators. Use Revman5.3 to process data. Results: a total of 12 retrospective controlled studies involving 2058 patients were included in Meta analysis. 鍒嗘瀽緇撴灉琛ㄦ槑:鍦ㄦ不鐤椾復搴娾厾鏈烴SCLC,鑳歌厰闀滀笅鑲烘鍒囬櫎鍜岃偤鍙跺垏闄ゅ湪鏈悗1騫寸敓瀛樼巼(OR=0.95 95%CI:0.21~4.25,P=0.950.05),3騫寸敓瀛樼巼(OR=1.36 95%CI:0.61~3.04,P=0.450.05),5騫寸敓瀛樼巼(OR=0.87 95%CI:0.56~1.34,P=0.530.05),鎬誨鍙戠巼(OR=0.8095%CI:0.49~1.29,P=0.350.05),灞，

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