Isala klinieken, Department of Pulmonary Diseases, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Respir Med. 2012 Nov;106(11):1600-5. doi: 10.1016/j.rmed.2012.08.005. Epub 2012 Aug 24.
No consensus exists on the exact treatment of pneumothorax (PTX). Some guidelines are proposing manual aspiration (MA) to be preferred over tube thoracostomy (TT) in uncomplicated primary spontaneous pneumothorax (PSP). However, only a few studies reported a direct comparison of both methods. Our aim was to re-evaluate this with a randomised trial in a single centre in the Netherlands.
Patients with a first episode of symptomatic PTX admitted to the ER or asymptomatic PTX with a size of ≥20% were recruited during 2007-2009 and followed-up for one year. Randomisation between MA and TT was balanced by a computer minimisation program for cause of PTX, smoking and gender. When first MA attempt failed, a second attempt was not undertaken and patients underwent TT. (registered at ClinicalTrials.gov (NCT00556335).
56 patients were included. Baseline characteristics were similar. Immediate success rates were 68.0% for MA versus 80.6% for TT (p = 0.28). Two week success rates were 100% in both groups. There was a significant difference in hospital stay in favour of MA: 2.4 ± 2.6 versus 4.4 ± 3.3 days (p = 0.02). One year recurrence rates in MA were lower than in TT, although not statistically significant (4.0% and 12.9% p = 0.37). Predictors of immediate success were traumatic PTX and female sex. One patient died during follow-up due to heart failure.
MA is simple, safe, cheap, minimal invasive in uncomplicated PSP/traumatic PTX with similar success and recurrence rates and a shorter hospital stay in comparison to TT and therefore the treatment of choice.
目前对于气胸（PTX）的具体治疗方法尚无共识。一些指南建议，在单纯性原发性自发性气胸（PSP）中，手动抽气（MA）优于胸腔引流管（TT）。然而，仅有少数研究报告了这两种方法的直接比较。我们的目的是在荷兰的一个单一中心进行一项随机试验，重新评估这一问题。
在 2007 年至 2009 年期间，我们招募了急诊科就诊的首次出现症状性气胸或气胸量≥20%的无症状性气胸患者，并随访一年。MA 和 TT 之间的随机分组通过计算机最小化程序平衡了气胸的病因、吸烟和性别。首次 MA 尝试失败后，不再进行第二次尝试，患者接受 TT。（在 ClinicalTrials.gov 注册（NCT00556335）。
共纳入 56 例患者。基线特征相似。MA 的即刻成功率为 68.0%，TT 为 80.6%（p=0.28）。两组两周的成功率均为 100%。MA 的住院时间明显短于 TT：2.4±2.6 天与 4.4±3.3 天（p=0.02）。MA 组一年复发率低于 TT 组，但无统计学意义（4.0%和 12.9%，p=0.37）。即刻成功的预测因素为创伤性气胸和女性。一名患者在随访期间因心力衰竭死亡。
在单纯性 PSP/创伤性气胸中，MA 操作简单、安全、廉价、微创，与 TT 相比，成功率和复发率相似，住院时间更短，因此是首选治疗方法。
