目的

评价剑突下入路电视胸腔镜手术（S-VATS）与侧胸入路电视胸腔镜手术（Ⅰ-VATS）治疗纵隔肿瘤的近期疗效和安全性。

方法

计算机检索Pubmed、Embase、ScienceDirect、Cochrane 图书馆、中国知网、中国生物医学文献数据库、中文科技期刊全文数据库和万方数字化期刊，检索时间均从建库至2019年3月。纳入有关S-VATS 与Ⅰ-VATS 治疗纵隔肿瘤的对比研究，根据Cochrane Handbook 5 .1 .0 质量评价标准评价纳入文献的质量。运用RevMan5 .3 软件对数据进行定量合并。

结果

最终纳入12 篇文献，其中包括1 项随机对照试验（RCT）和11 项病例对照研究，共889 例患者。荟萃分析（Meta 分析）结果显示：与Ⅰ-VATS 比较，S-VATS 术中失血量[MD（95% CI）：-24 .54（-36 .99，-12 .09），P＜0 .001]、术后引流量[MD（95% CI）：-209 .33（-292 .98，-125 .68），P＜0 .001]、术后带管时间[MD（95% CI）：-0 .91（-1 .24，-0 .59），P＜0 .001]、术后并发症发生率[OR（95% CI）：0 .36（0 .17，0 .74），P＝0 .006]、止痛药物干预时间[MD（95% CI）：-1 .33（-1 .92，-0 .75），P＜0 .001]、住院时间[MD（95% CI）： -2 .18（-3 .34，-1 .02），P ＝0 .02]均显著减少。S-VATS 与Ⅰ-VATS的手术时间及术后重症肌无力缓解情况的差异无统计学意义[MD（95% CI）：- 5 .11（-23 .37，13 .15），P＝0 .58 ；OR（95% CI）：0 .48（0 .21，1 .06），P＝0 .07]。

结论

S-VATS 治疗纵隔肿瘤安全可行。与Ⅰ-VATS 比较，S-VATS 具有术中失血量和术后引流量少、术后并发症发生率低、术后带管时间短、术后疼痛轻等优点。鉴于纳入文献的总体质量偏低，建议开展更多设计合理、多中心大样本的高质量随机对照研究，提供更高级别的证据。

Objective

To evaluate the efficacy and safety of subxiphoid approach video-assisted thoracoscopic surgery(S-VATS) and Intercostal approach video-assisted thoracoscopic surgery(I-VATS)for mediastinal tumors .

Methods

All randomized controlled trial or controlled clinical trial about SVATS and I-VATS of mediastinal tumors were searched from PubMed , EMBASE ,ScienceDirect ,Cochrane Library ,China National Knowledge Infrastructure , Chinese Biomedical Literature Database ,Chinese Science and Technology Academic Journal and Wanfang (from establishment to March 2019) ,to assess operating time , intraoperative blood loss , volume of drainage after surgery ,duration of chest drainage , duration of postoperative analgesics ,duration of hospital stay ,pulmonary and cardiac complications .The quality of the inclusion studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5 .1 .0 .The meta-analysis was conducted using RevMan5 .3 software .

Results

A total of 12 studies including 1 randomized controlled trials study and 11 case control studies , altogether involving 889 patients . Compared with I-VATS , S-VATS decreased significantly in intraoperative blood loss[MD(95% CI) : - 24 .54( -36 .99 , - 12 .09) , P＜0 .001] ,volume of drainage after surgery[MD(95% CI) :-209 .33( -292 .98 ,-125 .68) , P＜0 .001] ,duration of postoperative catheterization time [ MD ( 95% CI) : - 0 .91 ( - 1 .24 , - 0 .59) , P＜0 .001] ,postoperative complications[ OR(95% CI) :0 .36(0 .17 ,0 .74) ,P ＝0 .006] ,duration of postoperative analgesic intervention[MD(95% CI) :-1 .33( -1 .92 , -0 .75) , P＜0 .001] , and duration of hospital stay[MD(95% CI) : -2 .18( -3 .34 ,-1 .02) , P ＝ 0 .0002] . However , the relief of postoperative myasthenia gravis symptom [ OR(95% CI) :0 .48(0 .21 ,1 .06) , P＝0 .07] and operating time[MD(95%CI) :-5 .11( -23 .37 ,13 .15) , P ＝0 .58] were not significantly different .

Conclusions

The current evidence shows that S-VATS can reduce ,intraoperative blood loss ,volume of drainage after surgery ,duration of chest drainage ,duration of postoperative analgesics ,duration of hospital stay ,postoperative complications ,and would not increase postoperative myasthenia gravis symptom and operating time ,thus is a feasible and safe method in the treatment of mediastinal tumor .As the overall quality of enclosed literature is comparatively low , more reasonable , multiple-center and larger-sample RCT with higher quality would provide a higher level of evidence .