Kheir Fayez, Shawwa Khaled, Alokla Khalid, Omballi Mohamed, Alraiyes Abdul Hamid
1Department of Internal Medicine, Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA; 2Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, OH; and 3Department of Medicine, Interventional Pulmonology, Roswell Park Cancer Institute, Buffalo, NY.
Am J Ther. 2016 Nov/Dec;23(6):e1300-e1306. doi: 10.1097/MJT.0000000000000197.
Tunneled pleural catheter (TPC) has been widely used to control malignant pleural effusion (MPE); however, it is still not clear whether it is more effective than chemical pleurodesis. We performed a systematic review with meta-analysis to evaluate success and complication rate of TPC as compared with chemical pleurodesis in the management of MPE. PubMed, EMBASE, Cochrane central register of controlled trials, and MEDLINE were searched for English-language studies of clinical controlled trials comparing TPC with chemical pleurodesis until May 2014. Overall success and complication rate were evaluated. Relative risks (RRs) were estimated using random-effects model, and statistical heterogeneity was assessed using I test. Three trials involving 307 patients with MPE were included. The success rate was comparable between TPC and chemical pleurodesis group when all studies included in the analysis (RR, 0.8; 95% confidence interval, 0.53-1.19; P = 0.27). TPC had slightly higher complication rate but was not statistically significant (RR, 2; 95% confidence interval, 0.91-4.4; P = 0.09). Current evidence suggests that TPC and chemical pleurodesis are both effective treatment for recurrent MPE with similar success and complication rate. Further randomized controlled trials are needed to compare TPC with other therapies in patients with MPE.
隧道式胸腔导管（TPC）已被广泛用于控制恶性胸腔积液（MPE）；然而，它是否比化学性胸膜固定术更有效仍不清楚。我们进行了一项系统评价和荟萃分析，以评估在MPE治疗中TPC与化学性胸膜固定术相比的成功率和并发症发生率。检索了PubMed、EMBASE、Cochrane对照试验中央注册库和MEDLINE，以查找截至2014年5月比较TPC与化学性胸膜固定术的英文临床对照试验研究。评估了总体成功率和并发症发生率。使用随机效应模型估计相对风险（RRs），并使用I检验评估统计异质性。纳入了三项涉及307例MPE患者的试验。当分析中纳入所有研究时，TPC组和化学性胸膜固定术组的成功率相当（RR，0.8；95%置信区间，0.53 - 1.19；P = 0.27）。TPC的并发症发生率略高，但无统计学意义（RR，2；95%置信区间，0.91 - 4.4；P = 0.09）。目前的证据表明，TPC和化学性胸膜固定术都是治疗复发性MPE的有效方法，成功率和并发症发生率相似。需要进一步的随机对照试验来比较TPC与MPE患者的其他治疗方法。
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