Abdel Hady Sarah M, Elbastawisy Salma E, Hassaballa Aly S, Elsayed Hany H
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Thoracic surgery, Ain Shams University Hospital, Cairo, Egypt.
Interact Cardiovasc Thorac Surg. 2017 May 1;24(5):778-782. doi: 10.1093/icvts/ivw443.
A best evidence topic was written according to a structured protocol. The question addressed was: in surgically fit patients with biopsy proven symptomatic endobronchial hamartoma (EH), is surgical resection superior to bronchoscopic resection in terms of outcome. A total of 756 articles were identified using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. Three studies included patients who had either bronchoscopic or surgical treatment of EH in the same study. Modalities of surgery included performing a lobectomy, segmentectomy, bronchotomy and a pneumonectomy. Complete resection was 100% in the surgical group and ranged from 8% to 100% in the group treated bronchoscopically. Morbidity was present in 1 patient in a single study (6.6%) in the form of a pneumothorax after a bronchoscopic resection. No mortality was recorded in any study. A follow-up period of 16.2, 26 and up to 60 months showed recurrence of 26.7%, 12% and 0% respectively in the groups treated by bronchoscopy and no recurrence in the surgical group. Four studies looked at bronchoscopic treatment only for EH. Modalities of treatment included mechanical resection, laser, cryotherapy and Argon plasma coagulation. Complete resection ranged from 50-100% with patients achieving only partial resection requiring repeated endoscopic sessions. Morbidity was present in 3 out of the 4 studies; 1 case of pneumothorax in each of 2 studies (4.4% and 2%) and 25% morbidity rate in the third study (pneumothorax/airway stenosis). No mortality was present in any study. One study reported no recurrence after a median follow-up of 12.2 months, while another reported 50% recurrence, although the follow-up period was not stated. The final study included patients with EH treated only by surgical resection due to end stage lung damage caused by prolonged endobronchial obstruction. The majority of resections (71.4%) were in the form of lobectomies. Two major morbidities were recorded (28.5%) with no mortality. After a mean follow-up period of 7 years, no recurrences were recorded. To conclude, in biopsy proven symptomatic EHs, bronchoscopic treatment should be the first choice except in patients with end stage lung damage requiring surgical resection. Morbidity is low with pneumothorax the most common complication. Patients may require multiple sessions for complete removal as a significant recurrence rate is present, but is usually managed effectively by repeated bronchoscopic management.
根据结构化方案撰写了一篇最佳证据主题。所探讨的问题是：在经活检证实为有症状的支气管内错构瘤（EH）且适合手术的患者中，就治疗效果而言，手术切除是否优于支气管镜切除。通过报告的检索共识别出756篇文章，其中8篇代表了回答该临床问题的最佳证据。现将作者、日期、期刊、国家、研究类型、研究对象、治疗效果及关键结果制成表格列出。三项研究纳入了在同一研究中接受支气管镜或手术治疗EH的患者。手术方式包括肺叶切除术、肺段切除术、支气管切开术和全肺切除术。手术组的完全切除率为100%，而支气管镜治疗组的完全切除率在8%至100%之间。在一项研究中，1例患者（6.6%）出现并发症，表现为支气管镜切除术后气胸。所有研究均未记录到死亡病例。随访期为16.2个月、26个月及长达60个月时，支气管镜治疗组的复发率分别为26.7%、12%和0%，手术组无复发。四项研究仅观察了支气管镜治疗EH的情况。治疗方式包括机械切除、激光、冷冻疗法和氩等离子体凝固术。完全切除率在50%至100%之间，仅部分切除的患者需要多次内镜治疗。4项研究中有3项出现了并发症；2项研究各有1例气胸（4.4%和2%），第三项研究的并发症发生率为25%（气胸/气道狭窄）。所有研究均未出现死亡病例。一项研究报告中位随访12.2个月后无复发，另一项研究报告复发率为50%，但未说明随访期。最后一项研究纳入了因长期支气管内阻塞导致终末期肺损伤而仅接受手术切除治疗的EH患者。大多数切除术（71.4%）为肺叶切除术。记录到2例主要并发症（28.5%），无死亡病例。平均随访7年后，未记录到复发。总之，在经活检证实为有症状的EH患者中，除终末期肺损伤需要手术切除的患者外，支气管镜治疗应作为首选。并发症发生率低，气胸是最常见的并发症。由于存在显著的复发率，患者可能需要多次治疗才能完全切除，但通常通过反复支气管镜治疗可有效处理。
