Scarci Marco, Zahid Imran, Billé Andrea, Routledge Tom
Department of Thoracic Surgery, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
Interact Cardiovasc Thorac Surg. 2011 Jul;13(1):70-6. doi: 10.1510/icvts.2010.254698. Epub 2011 Mar 30.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether video-assisted thoracic surgery (VATS) is the best treatment for paediatric pleural empyema. Altogether 274 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that early VATS (or thoracotomy if VATS not possible) leads to shorter hospitalisation. The duration of chest tube placement and antibiotic use is variable and does not correlate with treatment method. Patients who underwent primary operative therapy had a lower aggregate in-hospital mortality rate (0% vs. 3.3%), re-intervention rate (2.5% vs. 23.5%), length of stay (10.8 days vs. 20.0 days), duration of tube thoracostomy (4.4 days vs. 10.6 days), and duration of antibiotic therapy (12.8 days vs. 21.3 days), compared with patients who underwent non-operative therapy. Similar complication rates were observed for the two groups (5% vs. 5.6%). Moreover, median hospital charges for VATS were $36,320 [interquartile range (IQR), $24,814-$62,269]. The median pharmacy and radiological imaging charges were $5884 (IQR, $3142-$11,357) and $2875 (IQR, $1703-$4950), respectively, for VATS and tube drainage. Adjusting for propensity score matching, costs for primary VATS were equivalent to primary chest tube placement. Only one article found discordant results. Ninety-five children (52%) received antibiotics alone, and 87 (45%) underwent drainage procedures (21 chest tube alone, 57 VATS/thoracotomy, and eight chest tube followed by VATS/thoracotomy); only four received fibrinolytics. Mean (standard deviation) length of stay was significantly shorter in the antibiotics alone group, 7.0 (3.5) days vs. 11 (4.0) days. The strongest predictors of undergoing pleural drainage were admission to the intensive care unit and large effusion size (>1/2 thorax filled).
根据结构化方案撰写了一篇胸外科最佳证据主题文章。所探讨的问题是电视辅助胸腔镜手术（VATS）是否是小儿胸腔积液的最佳治疗方法。通过报告的检索共找到274篇论文，其中15篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期和国家、研究的患者群体、研究类型、相关结局和结果均列表展示。我们得出结论，早期VATS（若无法进行VATS则行开胸手术）可缩短住院时间。胸管留置时间和抗生素使用时间各不相同，且与治疗方法无关。与接受非手术治疗的患者相比，接受一期手术治疗的患者总体住院死亡率较低（0%对3.3%）、再次干预率较低（2.5%对23.5%）、住院时间较短（10.8天对20.0天）、胸腔闭式引流时间较短（4.4天对10.6天）以及抗生素治疗时间较短（12.8天对21.3天）。两组观察到的并发症发生率相似（5%对5.6%）。此外，VATS的住院费用中位数为36,320美元[四分位间距（IQR），24,814 - 62,269美元]。VATS和胸腔闭式引流的药房和放射影像学费用中位数分别为5884美元（IQR，3142 - 11,357美元）和2875美元（IQR，1703 - 4950美元）。经倾向得分匹配调整后，一期VATS的费用与一期胸腔闭式引流相当。仅一篇文章发现了不一致的结果。95名儿童（52%）仅接受抗生素治疗，87名（45%）接受了引流手术（21名仅行胸腔闭式引流，57名行VATS/开胸手术，8名先行胸腔闭式引流后行VATS/开胸手术）；仅4名接受了纤维蛋白溶解剂治疗。仅接受抗生素治疗组的平均（标准差）住院时间显著较短，为7.0（3.5）天对11（
