胸腔镜下肺段切除术与肺叶切除术对肺肿瘤患者肺功能影响的荟萃分析

The Influence of Thoracoscopic Segmentectomy and Lobectomy on Lung Function in Patients with Lung Tumors: A Meta-Analysis

摘要: 目的：比较胸腔镜下肺段切除术与肺叶切除术对患者术后肺功能近远期的影响。方法：计算机检索中国知网、万方、维普、中国生物医学数据库、Web of Science、Cochrane图书馆、EMbase、PubMed等，收集胸腔镜下肺段切除术与肺叶切除术对肺功能影响的文献，搜索时间为建库起至2022年12月31日。对符合纳入标准的文献提取数据、质量评价后行Meta分析。结果：共纳入11项研究，包括肺叶切除术组844例，肺段切除术组777例。meta分析结果显示：FEV1 (WMD = −3.54, 95% CI −3.99~−3.09, P < 0.001)、FVC (WMD = −3.37, 95% CI −3.76~−2.97, P < 0.001)和MVV (WMD = −1.82, 95% CI −2.78~−0.86, P < 0.001)。结论：肺段切除术较肺叶切除术保留更多的肺功能。肺段切除组FEV1、FVC在3 m、6 m、12 m的肺功能变化率均小于肺叶切除组，肺段切除组MVV在3 m、6 m的下降比率低于肺叶切除组，而在12 m时的MVV两者之间没有差异。

Abstract: Objective: To compare the short-term and long-term effects of thoracoscopic segmentectomy and lobectomy on postoperative lung function. Methods: Clinical studies about effect of different surgical methods on lung function in patients with early NSCLC were searched from CNKI, Wanfang, VIP, China Biomedical Database, Web of Science, Cochrane Library, EMbase, PubMed, etc. The search pe-riod was from the establishment of the database to December 31, 2022. Meta-analysis was per-formed after data extraction and quality evaluation of the literatures meeting the inclusion criteria. Results: A total of 11 studies were included, including 844 patients in the lobectomy group and 777 patients in the segmentectomy group. The results of meta-analysis showed: FEV1 (WMD = −3.54, 95% CI −3.99~−3.09, P < 0.001), FVC (WMD = −3.37, 95% CI −3.76~−2.97, P < 0.001) and MVV (WMD = −1.82, 95% CI −2.78~−0.86, P < 0.001). Conclusion: Segmental resection preserves more lung func-tion than lobectomy. The change rates of FEV1 and FVC in segmental resection group at 3 m, 6 m and 12 m were lower than those in lobectomy group, and the decrease rate of MVV in segmental re-section group at 3 m and 6 m was lower than that in lobectomy group, while there was no difference in MVV between the two groups at 12 m.