Comparison Of Non-intubated Video-assisted Thoracic Surgery And Thoracoscopic Surgery With Routine Endotracheal Intubation In The Treatment Of Thoracic Diseases:Meta-analysis

ObjectiveVideo-assisted thoracic surgery(VATS)generally involves endotracheal intubation under general anesthesia.However,inevitably,this may cause intubation-related complications and prolong the postoperative recovery process.Gradually,non-intubated video-assisted thoracic surgery(NIVATS)is increasingly being utilized.However,its safety and efficacy remain controversial.MethodsRandomized controlled trials(RCTs)published up to August 2020 were selected from the Cochrane Library,Web of Science,Pub Med,Embase,and Clinical Trials.gov databases and included in this study according to the inclusion criteria.Two reviewers screened these RCTs and independently extracted the relevant data.Meta-analysis was performed using Review Manager 5.3.The results were length of hospital stay,duration of operation,field satisfaction score,anesthesia satisfaction score,visual analog scale(VAS),and incidence of complications.ResultsA total of 14 randomized controlled studies involving 1426 patients were included.Meta-analysis results showed that: In the non-tracheal intubation thoracoscopic surgery group,length of hospital stay [MD=-1.41,95%CI[-2.47,-0.34],P=0.01],postoperative VAS score[MD=-0.34,95%CI[-0.58,-0.10],P=0.006],total number of complications[OR=0.41,95%CI[0.25,0.67],P=0.0004],number of respiratory complications [OR=0.37,95%CI[0.21,0.66],P=0.0006],number of postoperative pneumothorax [OR=0.45,95%CI[0.24,0.87],P=0.02],number of intubation-related complications [OR=0.07,95%CI[0.04,0.16],P<0.00001],number of pharyngeal discomfort [OR=0.08,95%CI[0.04,0.17],P<0.00001],number of hoarseness [OR=0.06,95%CI[0.02,0.21],P<0.00001],number of gastrointestinal reactions[OR=0.23,95%CI[0.10,0.53],P=0.0005] and other indicators were lower than the control group,anesthesia satisfaction score [MD=0.39,95%CI[0.13,0.64],P=0.003] was higher than the control group,and the difference was statistically significant.And operation time[MD=0.90,95% CI[0.23,2.03],P=0.12] satisfaction Ⅰ series operation field[OR=0.73,95%CI[0.34,1.59],P=0.43]the difference of the index such as no statistical significance.ConclusionsNon-intubation thoracoscopic surgery has advantages in the incidence of complications,anesthesia satisfaction score and other aspects,the difference is statistically significant.There was no statistical significance in operative field score,operative time and other aspects.Clinicians should strictly grasp the indications according to the patient’s situation to accelerate the patient’s recovery process.