Elsayed Hany Hasan, Hassaballa Aly, Ahmed Taha
Thoracic Surgery Department, Ain Shams University Hospital, Cairo, Egypt
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Interact Cardiovasc Thorac Surg. 2016 Sep;23(3):459-61. doi: 10.1093/icvts/ivw154. Epub 2016 May 25.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was [in patients with secondary spontaneous pneumothorax (SSP)] is [video-assisted thoracoscopic surgery talc pleurodesis] superior to [talc pleurodesis through tube thoracostomy] in terms of [absence of recurrence and procedure morbidity]? Seventy-three papers were found using the reported search. In looking through our search strategy, we selected studies comparing both procedures and studies performing either procedures and stating their outcome, morbidity mortality and rate of recurrence. Hence, six studies and one society guideline represented the best evidence to answer the clinical question. The authors, journal, date, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Only one study compared both techniques and showed a higher length of hospital stay (14.2 vs 10.6 days; P = 0.033), higher rate of recurrence (30 vs 4.5%; P = 0.016) and higher mortality (5 vs 0%; P = 0.280) with tube thoracostomy talc pleurodesis in comparison with video-assisted thoracoscopic surgery (VATS) talc pleurodesis. Two studies looked at talc pleurodesis via tube thoracostomy (TT) alone for patients with secondary spontaneous pneumothorax (SSP). Talc pleurodesis was associated with an immediate success rate of 78.1 and 78.6%, with a short-term recurrence rate of 21.9 and 21.4%. No mortality was recorded in any study, but 1 patient (1.6%) in one study suffered from respiratory distress. No long follow-up periods were available in both studies; hence, there is no recording of long-term recurrence. Three studies looked at VATS talc pleurodesis alone in SSP patients. The procedure was associated with higher immediate success rates (90-100%) than TT pleurodesis alone with lower recurrence rates (0-10%). Average hospital stay was in the range of 3-4.7 days. Follow-up periods were 18, 22.7 and 24 months with recurrence rate ranging from 0 to 15%. No study was associated with major postoperative morbidity or in-hospital mortality. In conclusion, while there is only one study directly comparing both VATS and tube thoracostomy talc pleurodesis, the best evidence suggests that VATS talc pleurodesis for patients with secondary spontaneous pneumothorax should be considered the treatment of choice as it is associated with a higher immediate success rate, lower recurrence rate and a lower mortality than talc pleurodesis via tube thoracostomy.
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，在继发性自发性气胸（SSP）患者中，电视辅助胸腔镜滑石粉胸膜固定术在无复发和手术并发症方面是否优于经胸腔闭式引流管滑石粉胸膜固定术？通过报告的检索策略共找到73篇论文。在梳理检索策略时，我们选择了比较这两种手术的研究，以及实施其中任何一种手术并阐述其结果、并发症、死亡率和复发率的研究。因此，六项研究和一项学会指南构成了回答该临床问题的最佳证据。现将这些论文的作者、期刊、日期、研究的患者组、研究类型、相关结果和结果制成表格。只有一项研究对两种技术进行了比较，结果显示与电视辅助胸腔镜手术（VATS）滑石粉胸膜固定术相比，经胸腔闭式引流管滑石粉胸膜固定术的住院时间更长（14.2天对10.6天；P = 0.033）、复发率更高（30%对4.5%；P = 0.016）、死亡率更高（5%对0%；P = 0.280）。两项研究仅观察了经胸腔闭式引流管（TT）对继发性自发性气胸（SSP）患者进行滑石粉胸膜固定术的情况。滑石粉胸膜固定术的即刻成功率分别为78.1%和78.6%，短期复发率分别为21.9%和21.4%。所有研究均未记录到死亡病例，但一项研究中有1例患者（1.6%）出现呼吸窘迫。两项研究均未提供长期随访，因此未记录长期复发情况。三项研究仅观察了VATS对SSP患者进行滑石粉胸膜固定术的情况。该手术的即刻成功率（90 - 100%）高于单纯TT胸膜固定术，复发率较低（0 - 10%）。平均住院时间在3 - 4.7天范围内。随访期分别为18、22.7和24个月，复发率在0至15%之间变化。没有研究出现重大术后并发症或住院死亡率。总之，虽然只有一项研究直接比较了VATS和经胸腔闭式引流管滑石粉胸膜固定术，但最佳证据表明，对于继发性自发性气胸患者，VATS滑石粉胸膜固定术应被视为首选治疗方法，因为与经胸腔闭式引流管滑石粉胸膜固定术相比，它具有更高的即刻成功率、更低的复发率和更低的死亡率。
