| Part 1 Pulmonary Segmentectomies versus wedge resections for early stage non-small cell lung cancer: a Meta analysisObjective: Our study use meta-analysis to compare advantages and disadvantages of segmentectomies or wedge resections for early stage non–small cell lung cancer.Method: We searched Pubmed,EMbase,OVID,Cochrane Library,CNKI,and WFPD database to collect randomized controlled trials(RCTs)and non-randomized clinical trials(n RCTs)of segmentectomies versus wedge resections for early stage non-small cell lung cancer.Each database was searched from establishment to June 2017 by two researcher.And collected the data according to the integration and elimination standard,using Rev Man5.3 meta-analysis software.Results: We finally identified 1 RCTs and 10 n RCTs research involving 3474 patients.There were 1107 patients in the segmentectomies group and 2367 patients in the wedge resections group.The meta-analysis result showed that compared with wedge resections,patients received segmentectomy surgery had a longer operation time [WMD 12.25;95%CI 8.18~16.32 P<0.000 01] and hospital stay [WMD 1.31;95%CI 0.79~1.84 P<0.000 01],and lower local recurrence rates [OR 0.23;95%CI 0.15~0.37 P<0.000 01].patients receiving segmentectomy also showed superiority for 5-year survival rates [OR 2.95;95%CI 2.05~4.25 P<0.000 01],overall survival rates [HR 0.81;95%CI 0.69~0.95 P=0.008] and lymph node dissection [WMD 4.09;95%CI 2.97~5.22 P<0.000 01].While there was no statistical difference in the cancer distant metastasis rates [OR 0.73;95%CI 0.38~1.39 P=0.34] and complications rates [OR1.46;95%CI 0.75~2.82 P=0.26].Conclusion: Compared with wedge resections,patients received segmentectomy surgery had a better survival quality,a lower cancer recurrence rate.But also had a longer operation time and hospital stay.And more high-quality,multiple-center,large-sample research is expected.Part 2 Related factors of atelectasis after sublobar resections for early non small cell lung cancer: a Logistics analysisObjective: To explore the related factors of atelectasis after sublobar resection,and provide reference for the clinical prevention and treatment.Methods: The clinical data of 122 early non small cell lung cancer patients with sublobar resections were retrospectively analyzed,all the cases were divided in the differents groups according to the complications of atelectasis occurred or not.Single-factor analysis was adopted to analysis patients ages,genders,smoking history,preoperative pulmonary function,basic lung disease,expectoration capacity,the time of One-lung ventilation,surgical approach,resection range,the usage of antibiotics.We extracted statistically significant factors,and detected the multicollinearity of them.Lastly,make multiple regression logistics analysis for the meaningful variables.Results Univariate analysis showed that smoking history,preoperative pulmonary function,basic lung disease,expectoration capacity and the time of One-lung ventilation(OLV)were related with atelectasis after pneumoresection(P<0.05).Logistics multivariate regression showed that patients’ preoperative pulmonary(P=0.043),basic lung disease(P=0.05),expectoration capacity(P<0.000)and the time of One-lung ventilation(P=0.001)were independent risk factors for atelectasis after pneumoresection.The accuracy of this model forecast result was 91.8%,and the sensitivity result was 96.9%,and 72.0% was the result of specificity.Conclusion There are many risk factors of atelectasis after pneumoresection,among of this,Patients’ preoperative pulmonary,basic lung disease,expectoration capacity and the time of One-lung ventilation have a significant relationship with it.Aimed to these reasons,taking preventive measures can reduce the occurrence rate of atelectasis,and also can reduce the recover time.whereas,the risk factors in our research is incomplete,and further research is needed. |
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